Individual
DR. GRANT CHARLES WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MERCY CIRCLE, OCEANSIDE, CA 92055
(760) 719-3479
Mailing address
200 MERCY CIRCLE, OCENSIDE, CA 92055
(760) 719-3479
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G80310
CA
Other
Enumeration date
10/12/2005
Last updated
09/25/2023
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