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General NPI Number Information
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NPI Number | 1063678894
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Entity Type | Organization
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Legal Business Name | MICHAEL N WALL, MD
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 4085 DE ZAVALA RD SUITE 200
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2084
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Country | US
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Telephone | 210-558-6288
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Fax | 210-558-6289
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Provider Business Mailing Address
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Address Line | PO BOX 1606
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City | SAN ANTONIO
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State | TX
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Zip | 78296-1606
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Country | US
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Telephone | 210-558-6299
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Fax | 210-558-6289
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL N WALL
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Credential | MD
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Telephone | 210-558-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G1227
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License Number State | TX
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