Healthcare Provider Details

I. General information

NPI: 1861416661
Provider Name (Legal Business Name): NORMAN WALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 OLD EUREKA WAY STE 1E
REDDING CA
96001-0228
US

IV. Provider business mailing address

2701 OLD EUREKA WAY STE 1E
REDDING CA
96001-0228
US

V. Phone/Fax

Practice location:
  • Phone: 530-232-3000
  • Fax: 530-242-8545
Mailing address:
  • Phone: 530-232-3000
  • Fax: 530-242-8545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number04997
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number04997
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: