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General NPI Number Information
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NPI Number | 1508179284
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Entity Type | Organization
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Legal Business Name | RICHARD L WALLNER MD PA
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 2715 BOLTON BOONE DR SUITE A
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City | DESOTO
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State | TX
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Zip | 75115-2078
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Country | US
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Telephone | 972-296-0086
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Fax | 972-298-5536
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Provider Business Mailing Address
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Address Line | 2715 BOLTON BOONE DR SUITE A
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City | DESOTO
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State | TX
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Zip | 75115-2078
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Country | US
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Telephone | 972-296-0086
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Fax | 972-298-5536
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD WALLNER
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Credential |
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Telephone | 972-296-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | F7283
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License Number State | TX
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