Individual
STEPHEN JAY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 FACILITY DR, CLYDE, NC 28721-9438
(828) 452-2211
(828) 452-4421
Mailing address
15 FACILITY DR, CLYDE, NC 28721-9438
(828) 452-2211
(828) 452-4421
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
38234
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1270239
UNITED HEALTHCARE
—
05
—
8985406
—
NC
Enumeration date
08/10/2005
Last updated
07/08/2007
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