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General NPI Number Information
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NPI Number | 1467687236
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Entity Type | Organization
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Legal Business Name | NORMAN WALL DO INC.
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 1370 RAILROAD AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1124
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Country | US
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Telephone | 707-963-4399
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Fax | 707-963-4796
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Provider Business Mailing Address
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Address Line | 1370 RAILROAD AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1124
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Country | US
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Telephone | 707-963-4399
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Fax | 707-963-4796
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORMAN MAYNARD WALL III
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Credential | DO
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Telephone | 707-963-4399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20A7180
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License Number State | CA
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