Individual
STEVEN B WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3005 W INA RD, SUITE 123, TUCSON, AZ 85741-2107
(520) 575-9110
(520) 575-8033
Mailing address
3005 W INA RD, SUITE 123, TUCSON, AZ 85741-2107
(520) 575-9110
(520) 575-8033
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2113
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260703
—
AZ
01
—
AZ0064670
BLUE CROSS/BLUE SHIELD
AZ
Enumeration date
09/22/2006
Last updated
07/08/2007
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