Provider Demographics
NPI:1942298161
Name:WALSH, JOHN STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STUART
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 1:2330 130TH AVE NE #201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-455-9945
Mailing Address - Fax:425-455-9947
Practice Address - Street 1:2330 130TH AVE NE #201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-455-9945
Practice Address - Fax:425-455-9947
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72344207N00000X
WAMD00040702207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259935000Medicaid
FL41574OtherBLUECROSS/BLUESHIELD
FL070010259OtherRAILROAD MEDICARE
FLG29145Medicare UPIN
FL259935000Medicaid