Individual
DR. DOUGLAS MCKAY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 NW 16TH ST, MIAMI VA MEDICAL CENTER, DEPT OF NEUROLOGY, MIAMI, FL 33125-1624
(305) 575-7000
Mailing address
11104 SW 139TH CT, MIAMI, FL 33186-3251
(305) 387-7346
(305) 387-4632
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME94643
FL
Other
Enumeration date
02/12/2007
Last updated
07/08/2007
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