MEDICARE: JAMES FRANK WALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	14803	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES FRANK WALL MD

Provider Business Mailing Address
First Line	:	6608 N WESTERN AVE
Second Line	:	STE 473
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-917-9094
Fax Number	:	405-917-9096

Provider Business Practice Location Address
First Line	:	4301 NW 63RD ST
Second Line	:	STE 205
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1504
Country	:	US
Telephone Number	:	405-917-9094
Fax Number	:	405-917-9096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	02/13/2012

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Directions to “ JAMES FRANK WALL MD” Practice Location

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