Individual
DR. CLINTON WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 E SIOUX AVE, PIERRE, SD 57501-3323
(605) 224-3100
Mailing address
7466 RIPETTA ST, SARASOTA, FL 34240-4706
(239) 677-0555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
076987
GA
207Q00000X
Family Medicine Physician
Primary
ME134419
FL
390200000X
Student in an Organized Health Care Education/Training Program
21875
FL
Other
Enumeration date
05/28/2015
Last updated
10/18/2022
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