Provider Demographics
NPI:1255366290
Name:WALL, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:WALL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:9475 E IRONWOOD SQUARE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4576
Mailing Address - Country:US
Mailing Address - Phone:480-778-1400
Mailing Address - Fax:480-778-0400
Practice Address - Street 1:9475 E IRONWOOD SQUARE DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4576
Practice Address - Country:US
Practice Address - Phone:480-778-1400
Practice Address - Fax:480-778-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ24251207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG29332Medicare UPIN