Provider Demographics
NPI:1558431544
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
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Mailing Address - Street 1:1175 MAINSAIL DR UNIT 702
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8870
Mailing Address - Country:US
Mailing Address - Phone:207-446-0444
Mailing Address - Fax:239-206-2487
Practice Address - Street 1:1175 MAINSAIL DR UNIT 702
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-8870
Practice Address - Country:US
Practice Address - Phone:207-446-0444
Practice Address - Fax:239-206-2487
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-02-22
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Provider Licenses
StateLicense IDTaxonomies
ME010230207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB73162Medicare UPIN