Provider Demographics
NPI:1972501781
Name:WALSH, VINCENT PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PATRICK
Last Name:WALSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUCARE URB 2102 TURQUESA ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-287-6245
Mailing Address - Fax:787-287-6245
Practice Address - Street 1:BUCARE URB 2102 TURQUESA ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-287-6245
Practice Address - Fax:787-287-6245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0082213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR49000Medicare ID - Type Unspecified