Wall, Gail Jean

Wall, Gail Jean is an individual health care provider with primary practice located at 431 South Keech Street Halifax Health Keech Center, Daytona Beach FL 32114-4623. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Wall, Gail Jean can be contacted via phone (386) 947-3553.

Contact Information

Primary practice address
431 South Keech Street Halifax Health Keech Center Daytona Beach FL 32114-4623
Phone: (386) 947-3553
Fax: (386) 239-6189
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA0001553 Florida

Profile Details

NPI number 1700092095
LBN Legal business name Wall, Gail Jean
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2007
Last updated Sep 11th, 2009 - about 17 years 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700092095 NPPES
Florida Other PA0001553 PHYSICIAN ASSIST LICENSE
Florida MEDICAID 290055600 PHYSICIAN ASSIST LICENSE

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