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Individual

DOUGLAS C WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4072 GANTZ RD, GROVE CITY, OH 43123-4816
(614) 875-0011
(614) 539-7287
Mailing address
4072 GANTZ RD, GROVE CITY, OH 43123-4816
(614) 875-0011
(614) 539-7287

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.049780
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0586996
OH
Enumeration date
06/05/2006
Last updated
07/21/2023
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