Provider Demographics
NPI:1316250103
Name:WALSH, TRACY (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 9TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5887
Mailing Address - Country:US
Mailing Address - Phone:239-624-0940
Mailing Address - Fax:239-624-0941
Practice Address - Street 1:311 9TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5886
Practice Address - Country:US
Practice Address - Phone:239-624-0940
Practice Address - Fax:239-624-0941
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHH964ZOtherMEDICARE
FL009157000Medicaid
FL14Q9TOtherBCBS