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Individual

DR. TERRY J WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4323 WORNALL RD, RADIATION ONCOLOGY DEPT., KANSAS CITY, MO 64111-3229
(816) 932-2575
(816) 932-2344
Mailing address
6601 WINCHESTER AVE, SUITE 230, KANSAS CITY, MO 64133-4677
(816) 313-2667
(816) 313-6000

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
04-21400
KS
2085R0001X
Radiation Oncology Physician
Primary
R2G31
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100131660D
IA
05
207266107
MO
Enumeration date
04/10/2006
Last updated
04/21/2015
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