Provider Demographics
NPI:1891095030
Name:WALSTON, MICHAEL SHERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHERWIN
Last Name:WALSTON
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 1:9992 E COUNTRY SHADOWS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-5118
Mailing Address - Country:US
Mailing Address - Phone:520-886-2117
Mailing Address - Fax:
Practice Address - Street 1:3390 N. CAMPBELL AVE.
Practice Address - Street 2:SUITE #110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2380
Practice Address - Country:US
Practice Address - Phone:520-795-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47974207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology