Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D6751 | OR |
NPI | 1073588562 |
---|---|
Provider Name | Dr. Neil Marion Walle |
First Address | Klamath Falls, OR 97601-6012 |
Second Address | Klamath Falls, OR 97601-6012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 08/07/2007 |