Provider Demographics
NPI:1174506554
Name:WALL, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:WALL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5770 S 250 E
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8100
Mailing Address - Country:US
Mailing Address - Phone:801-747-8700
Mailing Address - Fax:801-747-8701
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:SUITE 290
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-747-8700
Practice Address - Fax:801-747-8701
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-05-26
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Provider Licenses
StateLicense IDTaxonomies
UT327834-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics