Provider Demographics
NPI:1902902620
Name:WALSKY, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:WALSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:19 GENERAL SAGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6396
Mailing Address - Country:US
Mailing Address - Phone:505-983-9460
Mailing Address - Fax:505-983-0568
Practice Address - Street 1:2212 BROTHERS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6903
Practice Address - Country:US
Practice Address - Phone:505-983-9460
Practice Address - Fax:505-983-0568
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78-2832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201010487OtherPHP
NM24216Medicaid
NM826133264OtherRAILROAD MEDICARE
NMNM002966OtherBCBS NM
NMPROVP17024OtherMOLINA SALUD
NMC98340Medicare UPIN
NMPROVP17024OtherMOLINA SALUD