Individual
JILLIAN MARIE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0777
(602) 933-0755
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A118542
CA
208000000X
Pediatrics Physician
P9987
TX
208M00000X
Hospitalist Physician
Primary
52240
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337651901
—
TX
05
—
337651902
—
TX
Enumeration date
09/20/2011
Last updated
03/29/2018
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