Healthcare Provider Details

I. General information

NPI: 1255366290
Provider Name (Legal Business Name): THOMAS J WALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 E IRONWOOD SQUARE DR STE 100
SCOTTSDALE AZ
85258-4576
US

IV. Provider business mailing address

9475 E IRONWOOD SQUARE DR STE 100
SCOTTSDALE AZ
85258-4576
US

V. Phone/Fax

Practice location:
  • Phone: 480-778-1400
  • Fax: 480-778-0400
Mailing address:
  • Phone: 480-778-1400
  • Fax: 480-778-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24251
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: