Individual
DR. JOHN WALL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
Mailing address
480 MERIDIAN ST, VILLAGE OF LAKEWOOD, IL 60014-5416
(815) 459-2658
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Enumeration date
11/23/2005
Last updated
07/09/2007
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