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NPI Code Detail

MEDICARE: JEAN OLDHAM WALL M.D.

MEDICARE: JEAN OLDHAM WALL M.D.
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
1207LP3000XPediatric Anesthesiology PhysicianG5445TX

Other Identifiers

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

General Provider Information

NPI Number : 1710982988
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN OLDHAM WALL M.D.
Provider Business Mailing Address
First Line : 2222 WELBORN ST
Second Line :
City : DALLAS
State : TX
Zip : 75219-3924
Country : US
Telephone Number : 214-559-5000
Fax Number : 214-443-7309
Provider Business Practice Location Address
First Line : 2222 WELBORN ST
Second Line :
City : DALLAS
State : TX
Zip : 75219-3924
Country : US
Telephone Number : 214-559-5000
Fax Number : 214-443-7309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 03/25/2016

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Directions to “ JEAN OLDHAM WALL M.D.” Practice Location

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