Individual
DR. CLARENCE R WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19829 N 27TH AVE, PHOENIX, AZ 85027-4001
(623) 879-5720
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
19342
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411025
—
AZ
Enumeration date
02/03/2006
Last updated
12/18/2013
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