MEDICARE: FURMAN M WALLS III MD

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	207P00000X	Emergency Medicine Physician	73306	MA
2	207R00000X	Internal Medicine Physician	73306	MA

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	:	1558357400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FURMAN M WALLS III MD

Provider Business Mailing Address
First Line	:	2100 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5615
Country	:	US
Telephone Number	:	617-296-4000
Fax Number	:	617-296-9618

Provider Business Practice Location Address
First Line	:	2100 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5615
Country	:	US
Telephone Number	:	617-296-4000
Fax Number	:	617-296-9618

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	05/27/2014

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