Individual
JOSEPH WALLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3635 VISTA AVE, WEST PAVILION, ROOM 315, SAINT LOUIS, MO 63110-2539
(314) 577-8776
(314) 268-5697
Mailing address
3635 VISTA AVE, WEST PAVILION, ROOM 315, SAINT LOUIS, MO 63110-2539
(314) 577-8776
(314) 268-5697
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2009013988
MO
207P00000X
Emergency Medicine Physician
251423
NY
207P00000X
Emergency Medicine Physician
MD436013
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03298666
—
NY
Enumeration date
07/11/2007
Last updated
02/09/2012
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