Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 24073 | AZ |
NPI | 1023014586 |
---|---|
Provider Name | Paul Edward Walshaw |
First Address | Tempe, AZ 85284-3495 |
Second Address | Benson, AZ 85602-6403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123577 | HEALTHNET (01) | |
379728 | (05) | AZ |
5231587 | ASTNA (01) | |
G31022 | (02) |