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1932770005
JACOB B WALL
BLOOMINGTON, IN
NPI
1932770005
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant Surgical
(Licence: IN 10003433A)
Enumeration Date
2021-07-08
Last Update Date
2024-01-30
Business Address
JACOB B WALL PA-C
415 S LANDMARK AVE
BLOOMINGTON, IN 47403-5003
Phone number: 812-333-7433
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Mailing Address
JACOB B WALL PA-C
801 YORK ST
MANITOWOC, WI 54220-4630
Phone number: 920-663-9008
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