Provider Demographics
NPI:1881797843
Name:WALLIN, ANTHONY R (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:WALLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 FORT UNION BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1889
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:1225 FORT UNION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:801-233-4410
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3105081205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine