Healthcare Provider Details

I. General information

NPI: 1285383695
Provider Name (Legal Business Name): TYLER JAMES WALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date: 03/22/2022
Reactivation Date: 04/22/2022

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8763
  • Fax: 888-435-7298
Mailing address:
  • Phone: 314-454-8763
  • Fax: 888-435-7298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026012715
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: