Individual
DR. ROBERT T WALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9330 MEDICAL PLAZA DR, CHARLESTON, SC 29406-9104
(843) 847-3225
(843) 847-3247
Mailing address
9330 MEDICAL PLAZA DR, CHARLESTON, SC 29406-9104
(843) 847-3225
(843) 847-3247
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2011042
SC
207R00000X
Internal Medicine Physician
Primary
11042
SC
207RH0003X
Hematology & Oncology Physician
11042
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110427
—
SC
05
—
GP3633
—
SC
Enumeration date
11/26/2005
Last updated
05/09/2013
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