Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35-035154 | OH |
NPI | 1043273154 |
---|---|
Provider Name | Dr. Patrick M Wall |
First Address | Columbus, OH 43214-3912 |
Second Address | Columbus, OH 43214-3912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0334730 | (05) | OH |