Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 30508 | NC |
NPI | 1003897224 |
---|---|
Provider Name | Dr. Robert Seth Wall |
First Address | Aurora, CO 80012-4132 |
Second Address | Camp Pendleton, CA 92055-5191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 08/07/2007 |