Individual
MICHAEL ABRAHAM WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-5747
Mailing address
4039 SW COUNCIL CREST DR, PORTLAND, OR 97239-1527
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
MD11411
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255505
—
OR
Enumeration date
08/01/2006
Last updated
07/08/2007
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