Individual
PAUL A WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18697 BAGLEY RD, CLEVELAND, OH 44130-3417
(440) 816-8000
Mailing address
PO BOX 634434, CINCINNATI, OH 45263-0001
(440) 879-0081
(440) 879-0084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-001348
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346913
ANTHEM
OH
Enumeration date
12/23/2005
Last updated
07/11/2007
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