Provider Demographics
NPI:1831152073
Name:WALL, TERRY J (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:J
Last Name:WALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6601 WINCHESTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4677
Mailing Address - Country:US
Mailing Address - Phone:816-313-2667
Mailing Address - Fax:816-313-6000
Practice Address - Street 1:4323 WORNALL RD
Practice Address - Street 2:RADIATION ONCOLOGY DEPT.
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3229
Practice Address - Country:US
Practice Address - Phone:816-932-2575
Practice Address - Fax:816-932-2344
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-04-21
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Provider Licenses
StateLicense IDTaxonomies
MOR2G312085R0001X
KS04-214002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA100131660DMedicaid
MO207266107Medicaid
KS422D880BMedicare PIN
MO207266107Medicaid
IA100131660DMedicaid