Organization
FLEMING ISLAND PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM WALLACE MD (MANAGER/OWNER)
(904) 990-3477
Entity
Organization
Contact information
Practice address
1715 EAGLE HARBOR PKWY STE B, FLEMING ISLAND, FL 32003-4324
(904) 990-3477
(904) 621-9272
Mailing address
916 ALAMEDA LN, SAINT JOHNS, FL 32259-6903
(904) 348-0727
(904) 621-9272
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME107749
FL
Other
Enumeration date
10/21/2015
Last updated
09/13/2024
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