Provider Demographics
NPI:1467687236
Name:NORMAN WALL DO INC.
Entity Type:Organization
Organization Name:NORMAN WALL DO INC.
Other - Org Name:NORMAN WALL DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:MAYNARD
Authorized Official - Last Name:WALL
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:707-963-4399
Mailing Address - Street 1:1370 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1124
Mailing Address - Country:US
Mailing Address - Phone:707-963-4399
Mailing Address - Fax:707-963-4796
Practice Address - Street 1:1370 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1124
Practice Address - Country:US
Practice Address - Phone:707-963-4399
Practice Address - Fax:707-963-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7180261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG96349Medicare UPIN
CA020A70800Medicare PIN