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Organization
WALLACE PHYSICIAN SERVICES LLC
Active
Organization
WALLACE PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYMON L WALLACE M.D. (PRESIDENT)
(513) 674-9601
Entity
Organization
Contact information
Practice address
1577 GOODMAN AVE STE A, CINCINNATI, OH 45224-1044
(513) 403-3762
(513) 521-6403
Mailing address
PO BOX 40535, CINCINNATI, OH 45240-0535
(859) 384-9045
(859) 212-0949
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-076674
OH
Other
Enumeration date
02/15/2011
Last updated
07/21/2022
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