Basic Information
| Provider Information | |||||||||
| NPI: | 1023014586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSHAW | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2149 E WARNER RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852843495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106100 | ||||||||
| FaxNumber: | 4806106189 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 S OCOTILLO AVE | ||||||||
| Address2: | |||||||||
| City: | BENSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856026403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206232642 | ||||||||
| FaxNumber: | 5203279300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 24073 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 123577 | 01 | HEALTHNET | OTHER | 379728 | 05 | AZ | MEDICAID | 5231587 | 01 | ASTNA | OTHER |