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Individual
DR. RICHARD A WALL
Active
Individual
DR. RICHARD A WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10250
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080088906
RAILROAD MEDICARE
AZ
05
—
255316
—
AZ
01
—
86080015085259A529
TRIWEST
AZ
01
—
86080015085260A099
TRIWEST
AZ
Enumeration date
11/30/2005
Last updated
09/27/2013
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