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Individual
DEBRA J WALLACE
Active
Individual
DEBRA J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22551
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000259190
ANTHEM BC & BS
KY
05
—
50002853
—
KY
05
—
64225519
—
KY
Enumeration date
03/01/2006
Last updated
03/11/2013
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