Individual
DR. SUEMOY S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1010 E MCDOWELL RD STE 103, PHOENIX, AZ 85006-2607
(800) 991-6117
(888) 812-8191
Mailing address
3820 NORTHDALE BLVD STE 201, TAMPA, FL 33624-1893
(800) 991-6117
(800) 812-8191
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
49311
AZ
202K00000X
Phlebology Physician
49311
AZ
208600000X
Surgery Physician
Primary
49311
AZ
2086S0102X
Surgical Critical Care Physician
49311
AZ
2086S0127X
Trauma Surgery Physician
49311
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
948235
—
AZ
Enumeration date
06/09/2009
Last updated
03/16/2026
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