Van Wall

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2018-00185 Issued in NC

Practice address

2817 Reilly St
Fort Bragg, NC 28310

Phone

(910) 907-6000

NPI assigned

Apr 18, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: vwall543370@wm.providencedirect.org

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

{
    "created_epoch": "1397779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1497175384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 FITZSIMMONS DR",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000",
            "telephone_number": "253-968-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 REILLY ST",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "28310",
            "telephone_number": "910-907-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9040 Fitzsimmons Dr",
            "address_purpose": "LOCATION",
            "city": "Joint Base Lewis McChord",
            "state": "WA",
            "postal_code": "984311000",
            "country_code": "US",
            "telephone_number": "253-968-2997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALL",
        "first_name": "VAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-18",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2018-00185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vern Alan Wagner
• Paul Allen Walck, PA
• Brandi Marie Walker, PHD
• Brooke Dionne Walker, PMHNP
• Rachel Walker, PA-C
• Brian Leslie Wallace, PT, DPT, OCS
• Gary Rhett Wallace, M.D., FAAFP
• Kathleen Lucille Walsh, M.D.
• Crystal Wang, MD
• Deneen S Wang, DDS

• Emergency Medicine Physician in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Emergency Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.