Provider Demographics
NPI:1194741009
Name:WALSH, RICHARD ALLAN III (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
Last Name:WALSH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2607
Mailing Address - Country:US
Mailing Address - Phone:719-531-7007
Mailing Address - Fax:719-531-7122
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-531-7007
Practice Address - Fax:719-531-7122
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36675208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00148227OtherRAILROAD MEDICARE
CO74988778Medicaid
H09125Medicare UPIN
COC477468Medicare PIN