Individual
MATTHEW WALSH
Active
Individual
MATTHEW WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
445
MT
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-445
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000097433
BCBS PIN
MT
01
—
123268100
MDCD PIN
WY
01
—
4308655
MDCD PIN
MT
Enumeration date
10/20/2005
Last updated
12/14/2021
Update your record
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