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Individual
TERRY WALL
Active
Individual
TERRY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15352
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000028828
—
AL
05
—
000085547
—
AL
05
—
009999665
—
AL
01
—
510-85547
BC BS
AL
01
—
E91805
VIVA
—
Enumeration date
07/20/2006
Last updated
01/13/2011
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