Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34-00-5836-W | OH |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | J9427 | TX |
N | 207Q00000X | Family Doctor | J9427 | TX |
NPI | 1508923848 |
---|---|
Provider Name | Ralph Claiborne Walsh JR. |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029633702 | (05) | TX |
051669 | (05) | OH |
8CS803 | BCBS (01) | TX |
F69086 | (02) | OH |
P01005491 | RAILROAD MEDICARE (01) | TX |