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NPI Code Detail

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

MEDICARE: DR. ROBERT W. 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
1207Q00000XFamily Medicine Physician19524NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15953OTHERNEMIDLANDS CHOICE
235215OTHERNEBCBS OF NEBRASKA
30101831OTHERNEUNITEDHEALTHCARE

General Provider Information

NPI Number : 1174602718
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT W. WALL M.D.
Provider Business Mailing Address
First Line : 250 N COLUMBIA AVE
Second Line :
City : SEWARD
State : NE
Zip : 68434-2226
Country : US
Telephone Number : 402-646-4622
Fax Number : 402-646-4635
Provider Business Practice Location Address
First Line : 250 N COLUMBIA AVE
Second Line :
City : SEWARD
State : NE
Zip : 68434-2226
Country : US
Telephone Number : 402-643-4800
Fax Number : 402-646-4635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 12/14/2012

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

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