Provider Demographics
NPI:1306983093
Name:WALSH, RAYMOND JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JAMES
Last Name:WALSH
Suffix:
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 1:4636 N JOSEY LN APT 2611
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4646
Mailing Address - Country:US
Mailing Address - Phone:214-608-4941
Mailing Address - Fax:
Practice Address - Street 1:4424 BLACK OTTER TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-5106
Practice Address - Country:US
Practice Address - Phone:214-608-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-2104207P00000X
TXM4977207P00000X
OK23828207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine