Individual
ERIK JACK WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(866) 785-8537
Mailing address
20 HIGHLAND VIEW CT, EASTON, PA 18042-9792
(484) 619-5066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA065385
PA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
07/31/2023
Last updated
02/12/2024
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