Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A60569 | CA |
NPI | 1023379583 |
---|---|
Provider Name | Dr. Ronald Walls |
First Address | Deerfield, IL 60015-2502 |
Second Address | Deerfield, IL 60015-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 31/05/2012 |