Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2012003521 | MO |
NPI | 1114108719 |
---|---|
Provider Name | Dr. Lindley B Wall |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Chesterfield, MO 63017-5705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209876309 | (05) | MO |