Provider Demographics
NPI:1043202377
Name:WALL, JAMES FRANK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANK
Last Name:WALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 N WESTERN AVE
Mailing Address - Street 2:STE 473
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7326
Mailing Address - Country:US
Mailing Address - Phone:405-917-9094
Mailing Address - Fax:405-917-9096
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:STE 205
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1504
Practice Address - Country:US
Practice Address - Phone:405-917-9094
Practice Address - Fax:405-917-9096
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100032000ADMedicaid
OK100032000AMedicaid
OK100032000AMedicaid
OK100032000ADMedicaid
D03604Medicare UPIN