Individual
DR. RICHARD AUSTIN WALLACE
Active
Individual
DR. RICHARD AUSTIN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
WV11648
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010107500
—
WV
01
—
1013957034
NPI
WV
Enumeration date
06/07/2006
Last updated
12/12/2012
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