Provider Demographics
NPI:1275504920
Name:WALSH, MOLLY F (DO)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:F
Last Name:WALSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14256 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3953
Mailing Address - Country:US
Mailing Address - Phone:480-657-2000
Mailing Address - Fax:480-657-2011
Practice Address - Street 1:5010 E SHEA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4615
Practice Address - Country:US
Practice Address - Phone:480-657-2000
Practice Address - Fax:480-657-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN471392086S0122X
AZ005628208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN423030200Medicaid
MN423030200Medicaid
MN240000285Medicare ID - Type Unspecified