Individual
SUSAN DALE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
28400
IA
207NS0135X
Procedural Dermatology Physician
28400
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079301
—
IA
Enumeration date
01/09/2006
Last updated
06/30/2022
Update your record
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