Provider Demographics
NPI:1841371994
Name:WALSH, KATHERINE B (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:B
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 1:4131 NW 13TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-1858
Mailing Address - Country:US
Mailing Address - Phone:352-376-1887
Mailing Address - Fax:
Practice Address - Street 1:4600 NEWBERRY ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2247
Practice Address - Country:US
Practice Address - Phone:352-367-2310
Practice Address - Fax:352-367-2512
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61193207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15114OtherBLUE CROSS & BLUE SHIELD
FL15114AMedicare ID - Type Unspecified
FLP00184934Medicare PIN
FL15114OtherBLUE CROSS & BLUE SHIELD