Individual
DR. MAEGEN J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-1000
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-3124
(402) 955-8140
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
69950
AZ
207XP3100X
Pediatric Orthopaedic Surgery Physician
28403
NE
390200000X
Student in an Organized Health Care Education/Training Program
2008018502
MO
Other
Enumeration date
07/12/2008
Last updated
06/30/2023
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