Individual
DR. WILLIAM DEAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZI0100X
Immunopathology Physician
Primary
168418-1205
UT
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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