Provider Demographics
NPI:1558368274
Name:WALSH, TIMOTHY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
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 1:13221 CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8572
Mailing Address - Country:US
Mailing Address - Phone:515-710-5112
Mailing Address - Fax:
Practice Address - Street 1:13221 CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8572
Practice Address - Country:US
Practice Address - Phone:515-710-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29285207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2097089Medicaid
IA50177OtherWELLMARK GROUP #
IA50177Medicare ID - Type UnspecifiedGROUP MEDICARE #
IAF56049Medicare ID - Type Unspecified
IA2097089Medicaid