Healthcare Provider Details

I. General information

NPI: 1134293061
Provider Name (Legal Business Name): RICHARD ALAN WAHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N WILMOT RD SUITE #101
TUCSON AZ
85711
US

IV. Provider business mailing address

2701 E ELVIRA RD
TUCSON AZ
85756-7124
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-9988
  • Fax: 520-694-9917
Mailing address:
  • Phone: 520-626-0923
  • Fax: 520-626-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15421
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number15421
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: