Individual
MICHAEL JAMES WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4015 I 45 N STE 310, CONROE, TX 77304-5077
(936) 520-8983
(936) 463-6508
Mailing address
PO BOX 95533, GRAPEVINE, TX 76099-9703
(936) 520-8983
(936) 463-6508
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J6047
TX
207RN0300X
Nephrology Physician
J6047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102913404
—
TX
Enumeration date
06/23/2005
Last updated
10/28/2024
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