Individual
ADAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EMT
Contact information
Practice address
341 E 12TH AVE, EUGENE, OR 97401-3212
(541) 345-6457
Mailing address
341 E 12TH AVE, EUGENE, OR 97401-3275
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
206430
OR
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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