Healthcare Provider Details

I. General information

NPI: 1932388998
Provider Name (Legal Business Name): MPWALL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRAL PARK DR SUITE 207
STEAMBOAT SPRINGS CO
80487-8816
US

IV. Provider business mailing address

940 CENTRAL PARK DR SUITE 207
STEAMBOAT SPRINGS CO
80487-8816
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-3200
  • Fax: 970-879-4608
Mailing address:
  • Phone: 970-879-3200
  • Fax: 970-879-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARYANN PURDY WALL
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 970-879-3200