Provider Demographics
NPI:1043301740
Name:WALSH, ALEXANDER CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:CRAIG
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4886
Mailing Address - Country:US
Mailing Address - Phone:213-483-8810
Mailing Address - Fax:213-975-9118
Practice Address - Street 1:301 S FAIR OAKS AVE STE 407
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:262-041-4106
Practice Address - Fax:213-975-9118
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA079504207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3452OtherMEDICARE
CA00A795040Medicaid
CA00A795040OtherBLUE SHIELD
CA00A795040Medicaid
CAWA79504CMedicare PIN
CAH73547Medicare UPIN
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW3452OtherMEDICARE
CAWA79504AMedicare PIN