Individual
DR. NEIL D WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
933 HIGHWAY 126, BRISTOL, TN 37620-3310
(423) 844-7000
(423) 844-7007
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 844-7000
(423) 844-7007
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
MD0000017754
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006002188
—
VA
05
—
1326043373
—
VA
05
—
1510634
—
TN
05
—
3032572
—
TN
Enumeration date
06/16/2005
Last updated
09/24/2009
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