Individual
JEFFREY A WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
190 STETSON RD, AUBURN, ME 04210-7813
(207) 784-7388
(207) 795-2043
Mailing address
190 STETSON RD, AUBURN, ME 04210-7813
(207) 784-7388
(207) 795-2043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1877
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048350
ANTHEM
ME
01
—
3769958
AETNA
ME
05
—
431799199
—
ME
01
—
9386763
PHCS
ME
01
—
9759878
CIGNA
ME
Enumeration date
06/28/2006
Last updated
03/24/2017
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