Wall, Bryan T
Wall, Bryan T is an individual health care provider with primary practice located at 18444 N 25Th Ave Ste 210, Phoenix AZ 85023-1264. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery is his primary health care specialty. Wall, Bryan T can be contacted via phone (623) 537-5600.Contact Information
Primary practice address
18444 N 25Th Ave Ste 210
Phoenix AZ 85023-1264
Phone: (623) 537-5600
Fax: (866) 939-2673
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 36177 | Arizona |
| Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery | 207XS0114X | 36177 | Arizona |
Profile Details
| NPI number | 1790712792 |
|---|---|
| LBN Legal business name | Wall, Bryan T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 26th, 2006 |
| Last updated | Apr 23rd, 2024 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790712792 | NPPES |
| Arizona | Other | 5550830006 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830008 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830009 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830007 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830010 | MEDICARE NSC ANTHEM |
| Arizona | Other | P00618125 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830003 | MEDICARE NSC ANTHEM |
| Arizona | MEDICAID | 159666 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830001 | MEDICARE NSC ANTHEM |
| Arizona | Other | 5550830004 | MEDICARE NSC ANTHEM |
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