Clarence R Wall, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

19342 Issued in AZ

Practice address

19829 N 27TH Ave
Phoenix, AZ 85027-4001

Phone

(623) 879-5720

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• C. Robert Wall Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chandler Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Chandler, AZ
  • NPI 1386602076
  NPD (past)
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1285338343
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1215909197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850617340",
            "telephone_number": "602-943-9200",
            "fax_number": "602-216-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19829 N 27TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274001",
            "telephone_number": "623-879-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "CLARENCE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "19342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "411025",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C. ROBERT",
            "last_name": "WALL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tony Walker
• Virginia Sue Walker, LPN
• Michael Denis Walkow
• Timothy William Walkowiak, NP-C
• Bryan T Wall, MD
• Heather Wall, LCSW
• Jillian Marie Wall, M.D.
• Liberty Morgan Wall
• Michael Vincent Wall, D.D.S.
• Richard A Wall, M.D.

• Diagnostic Radiology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Diagnostic Radiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.