Provider Demographics
NPI:1548468234
Name:WALL, DEENA LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:DEENA
Middle Name:LOUISE
Last Name:WALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STILLFOREST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7518
Mailing Address - Country:US
Mailing Address - Phone:713-952-5679
Mailing Address - Fax:713-952-3624
Practice Address - Street 1:13501 KATY FWY
Practice Address - Street 2:RM. W2-108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1305
Practice Address - Country:US
Practice Address - Phone:281-870-6908
Practice Address - Fax:281-588-2535
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH96062083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine