Provider Demographics
NPI:1326073719
Name:WALSH, JOHN JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:WALSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2820 NAPOLEON AVE
Mailing Address - Street 2:640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-897-1327
Mailing Address - Fax:504-897-1364
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:640
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-897-1327
Practice Address - Fax:504-897-1364
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA15860174400000X
LAMD.0158602086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351393Medicaid
LA721461536OtherTIN
LAD79743Medicare UPIN
LA5O191Medicare ID - Type UnspecifiedLA MEDICARE