Provider Demographics
NPI:1508923848
Name:WALSH, RALPH CLAIBORNE JR (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:CLAIBORNE
Last Name:WALSH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-735-2235
Mailing Address - Fax:817-735-2480
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-2235
Practice Address - Fax:817-735-2480
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5836-W204D00000X
TXJ9427204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029633702Medicaid
OH051669Medicaid
TX8CS803OtherBCBS
TXP01005491OtherRAILROAD MEDICARE
TX029633702Medicaid
TXP01005491OtherRAILROAD MEDICARE