Individual
DR. WALLACE LLERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401-55 W ALLEGHENY AVE, PHILADELPHIA, PA 19133-3644
(215) 291-2500
(215) 291-2587
Mailing address
1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2908
(215) 599-4851
(215) 232-4093
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MD038236L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001019428 - 0022
—
PA
Enumeration date
11/21/2005
Last updated
06/07/2011
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