Provider Demographics
NPI:1922047935
Name:WALSH, CRAIG R (MD MPH)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD MPH
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 498
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-216-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049327207RC0000X
ORMD23763207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286755Medicaid
WA8367153Medicaid
ORP00848629OtherRR MEDICARE
WAP00991143OtherRR MEDICARE
WAP00991143OtherRR MEDICARE
WA8367153Medicaid
ORR154621Medicare PIN
ORH45911Medicare UPIN
ORR159883Medicare PIN
WAG8897320Medicare PIN
OR286755Medicaid
ORR156596Medicare PIN
ORR154621Medicare PIN