Individual
JOHN ALAN WALSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14 OFFICE PARK DR STE 7, PALM COAST, FL 32137-3830
(386) 302-5064
(386) 302-5093
Mailing address
14 OFFICE PARK DR STE 7, PALM COAST, FL 32137-3830
(386) 302-5064
(386) 302-5093
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME78805
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111087700
—
FL
01
—
225976
HEALTHEASE MEDICAID
FL
01
—
P00119721
RAILROAD MEDICARE
FL
01
—
Q0466
MEDICARE
—
Enumeration date
11/15/2006
Last updated
07/29/2021
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