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Individual
HAILY WALLACE
Active
Individual
HAILY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2014-0895
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2012
Last updated
06/18/2015
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