Individual
MR. WALLACE TRANUM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 GOLDEN ARM RD, DELTONA, FL 32738-8653
(407) 460-7242
Mailing address
415 GOLDEN ARM RD, DELTONA, FL 32738-8653
(407) 460-7242
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T655898694600
FL
Other
Enumeration date
10/26/2019
Last updated
10/26/2019
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