Organization
GARY S WALLACH DPM PA
Active
Organization
GARY S WALLACH DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY S WALLACH D.P.M. (PRESIDENT)
(954) 561-3338
Entity
Organization
Contact information
Practice address
2737 E OAKLAND PARK BLVD, FT LAUDERDALE, FL 33306-1641
(954) 561-3338
(954) 566-3051
Mailing address
2737 E OAKLAND PARK BLVD, FT LAUDERDALE, FL 33306-1641
(954) 561-3338
(954) 566-3051
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041067500
—
FL
01
—
DN9665
RAILROAD MEDICARE
FL
Enumeration date
08/16/2006
Last updated
01/16/2013
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