Organization
THE WALLACE MEDICAL CONCERN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ROLLER (OPERATIONS DIRECTOR)
(503) 489-1760
Entity
Organization
Contact information
Practice address
254 NW BURNSIDE ROAD, GRESHAM, OR 97030
(503) 489-1760
Mailing address
254 NW BURNSIDE ROAD, GRESHAM, OR 97030
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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