Organization
JANET N. WALLACE, MD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET N WALLACE MD (PRESIDENT)
(304) 697-0554
Entity
Organization
Contact information
Practice address
2703 3RD AVE, HUNTINGTON, WV 25702-1303
(304) 697-0554
(304) 697-0555
Mailing address
2703 3RD AVE, HUNTINGTON, WV 25702-1303
(304) 697-0554
(304) 697-0555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0046053000
—
WV
Enumeration date
12/05/2006
Last updated
11/13/2007
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