Individual
DIANE WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604
(801) 357-7850
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6820890-1205
UT
207P00000X
Emergency Medicine Physician
MD21813
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2015
Last updated
04/14/2026
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