Individual
MICHAEL N. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4085 DE ZAVALA RD, SUITE 200, SHAVANO PARK, TX 78249-2084
(210) 558-6288
(210) 558-6289
Mailing address
PO BOX 1606, SAN ANTONIO, TX 78296-1606
(210) 558-3628
(210) 558-6289
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
G1227
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035387201
—
TX
Enumeration date
06/05/2006
Last updated
03/25/2015
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