MEDICARE: DR. ROBERT E. WALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	20319	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114916004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E. WALL M.D.

Provider Business Mailing Address
First Line	:	4900 S MONACO ST STE 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-3487
Country	:	US
Telephone Number	:	303-322-2240
Fax Number	:	303-322-9260

Provider Business Practice Location Address
First Line	:	2055 HIGH ST
Second Line	:	SUITE 140
City	:	DENVER
State	:	CO
Zip	:	80205-5503
Country	:	US
Telephone Number	:	303-322-2240
Fax Number	:	303-322-9260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	06/22/2016

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Directions to “ DR. ROBERT E. WALL M.D.” Practice Location

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