Provider Demographics
NPI:1235328873
Name:WALL, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1811 N BELCHER RD
Mailing Address - Street 2:SUITE H-2
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1433
Mailing Address - Country:US
Mailing Address - Phone:727-672-4637
Mailing Address - Fax:727-724-6377
Practice Address - Street 1:1811 N BELCHER RD
Practice Address - Street 2:SUITE H-2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1433
Practice Address - Country:US
Practice Address - Phone:727-724-6373
Practice Address - Fax:727-724-6377
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2015-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL48335207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62581Medicare UPIN