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Organization
SCOTT C. WALLACE MD INC
Active
Organization
SCOTT C. WALLACE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT C WALLACE MD (OWNER/PHYSICIAN)
(765) 284-0493
Entity
Organization
Contact information
Practice address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(301) 305-5959
Mailing address
PO BOX 112, MUNCIE, IN 47308-0112
(765) 284-0493
(765) 284-2434
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
—
Other
Enumeration date
11/06/2018
Last updated
01/16/2020
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