Individual
JOHN GEORGE WALLACE JR.
Active
Individual
JOHN GEORGE WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
G45690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G456900
—
CA
Enumeration date
06/19/2006
Last updated
09/19/2012
Update your record
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