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General NPI Number Information
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NPI Number | 1154491934
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Entity Type | Organization
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Legal Business Name | BARRY J WALLMAN MD
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29525 CAN WOOD ST # 305
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City | AGOURA HILLS
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State | CA
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Zip | 91301
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Country | US
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Telephone | 818-707-7789
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Fax | 818-707-7797
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Provider Business Mailing Address
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Address Line | 29525 CAN WOOD ST # 305
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City | AGOURA HILLS
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State | CA
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Zip | 91301
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Country | US
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Telephone | 818-707-7789
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Fax | 818-707-7797
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | BARRY J WALLMAN
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Credential | MD
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Telephone | 818-707-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G72087
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G58527
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License Number State | CA
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