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Individual
DAVID WALLACE
Active
Individual
DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
15448
MS
207L00000X
Anesthesiology Physician
Primary
272263-1205
UT
207L00000X
Anesthesiology Physician
5101010132
MI
207L00000X
Anesthesiology Physician
O-168
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D4253
—
UT
Enumeration date
09/08/2005
Last updated
10/10/2007
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