Individual
DR. RICHARD AUSTIN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1306 KANAWHA BLVD E, CHARLESTON, WV 25301-3001
(304) 343-4371
(304) 353-0215
Mailing address
1306 KANAWHA BLVD E, CHARLESTON, WV 25301-3001
(304) 343-4371
(304) 353-0215
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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