Individual
GAIL JEAN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
431 SOUTH KEECH STREET, HALIFAX HEALTH KEECH CENTER, DAYTONA BEACH, FL 32114-4623
(386) 947-3553
(386) 239-6189
Mailing address
431 SOUTH KEECH STREET, HALIFAX HEALTH KEECH CENTER, DAYTONA BEACH, FL 32114-4623
(386) 947-3553
(386) 239-6189
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA0001553
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290055600
—
FL
01
—
PA0001553
PHYSICIAN ASSIST LICENSE
FL
Enumeration date
05/15/2007
Last updated
09/11/2009
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