Individual
MAX JOSEPH WALLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(774) 270-0554
Mailing address
3580 PALL MALL DR APT 2604, JACKSONVILLE, FL 32257-5486
(774) 270-0554
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME176656
FL
Other
Enumeration date
04/13/2020
Last updated
10/30/2025
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