Individual
DAVID WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 N PROSPECT AVE STE 309, REDONDO BEACH, CA 90277-3043
(424) 437-4700
(424) 437-8884
Mailing address
PO BOX 66657, SEATTLE, WA 98166-0657
(424) 437-4700
(424) 437-8884
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A77627
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A776270
BLUE SHIELD
CA
Enumeration date
05/17/2006
Last updated
10/09/2024
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