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Individual
DR. DOUGLAS WALLACE
Active
Individual
DR. DOUGLAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
64623
TN
207P00000X
Emergency Medicine Physician
36768
AL
207P00000X
Emergency Medicine Physician
Primary
64623
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q064437
—
TN
Enumeration date
04/09/2016
Last updated
04/25/2025
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