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General NPI Number Information
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NPI Number | 1376003350
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Entity Type | Individual
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Provider Name | KEVIN CORR WALL
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13048 RIVERS BEND RD
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City | CHESTER
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State | VA
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Zip | 23836-2564
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Country | US
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Telephone | 804-526-5888
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Fax | 804-828-4762
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Provider Business Mailing Address
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Address Line | 1200 E BROAD ST FL 9
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City | RICHMOND
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State | VA
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Zip | 23298-5025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101286887
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 1017961
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License Number State | MA
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