Basic Information
| Provider Information | |||||||||
| NPI: | 1609026608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCE PATRICK WALSH MD PHD A PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 NORTH JEFFERSON AVENUE | ||||||||
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| City: | MOUNT PLEASANT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754552338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035776000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 72057 HIGHWAY 111 | ||||||||
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| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922704927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467191 | ||||||||
| FaxNumber: | 7603467905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2008 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7603467191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | A98108 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.