Individual
MR. RYAN MICHAEL WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
HEALTH SERVICES TECH
Contact information
Practice address
5201 LEE RD, BUZZARDS BAY, MA 02542-1313
(508) 968-6572
(508) 968-6581
Mailing address
5425 CARPENTER AVE, APT A, BUZZARDS BAY, MA 02542-1587
(508) 968-6572
(508) 968-6581
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
B1552861
CA
Other
Enumeration date
12/14/2005
Last updated
07/08/2007
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