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Individual

MR. CLINTON BARRETT WALLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.T.

Contact information

Practice address
709 DOWNTOWNER LOOP W, MOBILE, AL 36609-5503
(251) 380-1111
(251) 380-1110
Mailing address
709 DOWNTOWNER LOOP W, MOBILE, AL 36609-5503
(251) 380-1111
(251) 380-1110

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2224
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
51514463
BCBS PROVIDER NUMBER
AL
Enumeration date
06/02/2006
Last updated
08/24/2007
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