Provider Demographics
NPI:1508882424
Name:WALLEN, JOSEPH JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JEFFREY
Last Name:WALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2850
Mailing Address - Country:US
Mailing Address - Phone:423-467-3527
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SIDNEY AND LAMONT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 0000021126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine