Provider Demographics
NPI:1316909377
Name:WALSH, RONALD LENNOX (DO)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LENNOX
Last Name:WALSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2282
Mailing Address - Country:US
Mailing Address - Phone:727-581-3550
Mailing Address - Fax:727-586-6190
Practice Address - Street 1:1345 W BAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2282
Practice Address - Country:US
Practice Address - Phone:727-581-3550
Practice Address - Fax:727-586-6190
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 5516207RC0001X
FLOS5516207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062335100Medicaid
FL062335100Medicaid
FLD14905Medicare UPIN