Individual
TOR ERIK WILLIAM WALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1394 W 16TH ST, YUMA, AZ 85364-4430
(928) 539-0055
(928) 539-0053
Mailing address
1394 W 16TH ST, YUMA, AZ 85364-4430
(928) 539-0055
(928) 539-0053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25545
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
469024001
—
AZ
Enumeration date
07/14/2006
Last updated
02/10/2012
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