Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD0000017754 | TN |
NPI | 1326043373 |
---|---|
Provider Name | Dr. Neil D Wallen |
First Address | Kingsport, TN 37662-0009 |
Second Address | Bristol, TN 37620-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 24/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006002188 | (05) | VA |
103I086169 | (02) | TN |
1326043373 | (05) | VA |
1510634 | (05) | TN |
3032572 | (05) | TN |
30325722 | (02) | TN |
A99617 | (02) | TN |