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NPI Code Detail

MEDICARE: BRUCE WALL M.D.

MEDICARE: BRUCE 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
1207RN0300XNephrology PhysicianG1312TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G1312OTHERTXTX MEDICAL LICENSE

General Provider Information

NPI Number : 1861446130
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE WALL M.D.
Provider Business Mailing Address
First Line : 1505 LBJ FWY STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75234-6065
Country : US
Telephone Number : 214-358-2300
Fax Number : 214-579-6941
Provider Business Practice Location Address
First Line : 13154 COIT RD STE 100
Second Line :
City : DALLAS
State : TX
Zip : 75240-5787
Country : US
Telephone Number : 214-358-2300
Fax Number : 214-579-6989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 06/03/2024

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Directions to “ BRUCE WALL M.D.” Practice Location

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