Individual
DR. JOHN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9321 W THOMAS RD STE 205, PHOENIX, AZ 85037-3392
(866) 974-2673
(866) 939-2673
Mailing address
1850 N CENTRAL AVE STE 1600, PHOENIX, AZ 85004-4633
(602) 262-8900
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301093046
MI
207L00000X
Anesthesiology Physician
52631
AZ
208VP0000X
Pain Medicine Physician
Primary
52631
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190894
—
AZ
Enumeration date
07/15/2008
Last updated
04/16/2026
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