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Individual
JONATHAN O WALLACE
Active
Individual
JONATHAN O WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
1101813
AL
367500000X
Certified Registered Nurse Anesthetist
1101813
AL
Other
Enumeration date
05/23/2006
Last updated
09/11/2025
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