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Individual

RICHARD J WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4011 TALBOT RD S, STE 460, RENTON, WA 98055-5773
(425) 251-5110
(425) 793-7382
Mailing address
PO BOX 50010, RENTON, WA 98058-5010
(425) 228-3440

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00042456
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00042456
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00042456
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0217509
L&I
WA
05
104443
WA
01
4033WA
REGENCE
WA
05
8472995
WA
01
P00601617
MED RAILROAD
WA
Enumeration date
12/28/2006
Last updated
08/14/2017
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