Individual
DR. JOHN DOUGLAS WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
9304 FOREST POINT CIR, MANASSAS, VA 20110-4700
(703) 368-1969
(703) 369-4164
Mailing address
9304 FOREST POINT CIR, MANASSAS, VA 20110-4700
(703) 368-1969
(703) 369-4164
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
0101044866
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6240259
—
VA
Enumeration date
08/10/2005
Last updated
10/13/2011
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