Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | DR.0060516 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | DR.0060516 | CO |
NPI | 1205161478 |
---|---|
Provider Name | Dr. Brooke Melissa Walls |
First Address | Austin, TX 78730-2309 |
Second Address | Aspen, CO 81611-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2009 |
Last Update Date | 14/02/2022 |