Provider Demographics
NPI:1871668988
Name:WALSH, JEROME M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:M
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1946 YOUNG ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2150
Mailing Address - Country:US
Mailing Address - Phone:808-973-7320
Mailing Address - Fax:808-973-7325
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-4233
Practice Address - Fax:808-522-3728
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-4264207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI502460 01Medicaid
HI0671444OtherUHA
HI00000232181OtherHMSA
HI00000232181OtherHMSA
HI53993Medicare ID - Type Unspecified