Provider Demographics
NPI:1801107487
Name:WALSH, ALLISON NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:NICOLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:621 S. NEW BALLAS RD.
Mailing Address - Street 2:4008
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-567-5017
Mailing Address - Fax:314-251-4282
Practice Address - Street 1:621 S. NEW BALLAS RD.
Practice Address - Street 2:4008
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-5017
Practice Address - Fax:314-251-4282
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2024-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010018516207V00000X
FLTPME5859207V00000X
IL36.165628207V00000X
ARE-16866207V00000X
MO2013040818207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013040818OtherSTATE LICENSE NUMBER