Individual
DR. RICHARD A WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19841 N 27TH AVE, STE. 101, PHOENIX, AZ 85027-4003
(602) 942-8512
(602) 942-1075
Mailing address
2500 W UTOPIA RD, STE. 100, PHOENIX, AZ 85027-4171
(623) 434-6200
(623) 434-6164
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10250
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080088906
RAILROAD MEDICARE
AZ
05
—
255316
—
AZ
01
—
86080015085259A529
TRIWEST
AZ
01
—
86080015085260A099
TRIWEST
AZ
Enumeration date
11/30/2005
Last updated
09/27/2013
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