Basic Information
| Provider Information | |||||||||
| NPI: | 1316909377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | LENNOX | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 W BAY DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337702282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275813550 | ||||||||
| FaxNumber: | 7275866190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 W BAY DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337702282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275813550 | ||||||||
| FaxNumber: | 7275866190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | OS 5516 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | OS5516 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 062335100 | 05 | FL | MEDICAID |