Individual
WALLACE CLEMENTS TARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
146 MEDICAL PARK RD, STE 206, MOORESVILLE, NC 28117-8528
(704) 799-3939
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
200200613
NC
2086S0129X
Vascular Surgery Physician
Primary
200200613
NC
Other
Enumeration date
03/09/2006
Last updated
07/16/2024
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