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1003899071
JOHN WALL
ROCKFORD, IL
NPI
1003899071
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: IL 036037806)
Enumeration Date
2005-11-23
Last Update Date
2007-07-09
Business Address
Dr. JOHN WALL MD
1200 W STATE ST
ROCKFORD, IL 61102-2112
Phone number: 815-490-1600
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Mailing Address
Dr. JOHN WALL MD
480 MERIDIAN ST
VILLAGE OF LAKEWOOD, IL 60014-5416
Phone number: 815-459-2658
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