Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | L2048 | TX |
NPI | 1225095953 |
---|---|
Provider Name | Dr. Donna A Wall |
First Address | San Antonio, TX 78229-3415 |
Second Address | San Antonio, TX 78229-3979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8585J5 | MEDICARE NUMBER (01) | TX |