Provider Demographics
NPI:1023014586
Name:WALSHAW, PAUL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:WALSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2149 E WARNER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:450 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6403
Practice Address - Country:US
Practice Address - Phone:520-623-2642
Practice Address - Fax:520-327-9300
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24073207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
123577OtherHEALTHNET
AZ379728Medicaid
5231587OtherASTNA
123577OtherHEALTHNET
G31022Medicare UPIN