Provider Demographics
NPI:1255309340
Name:WALSH, JOSEPH BAILEY (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BAILEY
Last Name:WALSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 E STATE ROAD 64 STE 509
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9029
Mailing Address - Country:US
Mailing Address - Phone:941-243-9613
Mailing Address - Fax:941-202-6328
Practice Address - Street 1:4623 BLUE MARLIN DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-8488
Practice Address - Country:US
Practice Address - Phone:561-414-7889
Practice Address - Fax:941-202-6328
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7739208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260532500Medicaid
H25644Medicare UPIN
E4625BMedicare ID - Type Unspecified