Individual
JAMIE RUSSELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10752 N 89TH PL, #126, SCOTTSDALE, AZ 85260
(480) 860-1161
(480) 860-6561
Mailing address
10752 N 89TH PL, #126, SCOTTSDALE, AZ 85260
(480) 860-1161
(480) 860-6561
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12810
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226143-001
—
AZ
Enumeration date
05/05/2006
Last updated
07/21/2022
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