Individual
DR. AARON JACK WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4802 E JOHNSON AVE, JONESBORO, AR 72401-6007
(870) 936-8523
(870) 934-3633
Mailing address
PO BOX 1960, JONESBORO, AR 72403-1960
(870) 936-8523
(870) 934-3633
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E-6150
AR
207X00000X
Orthopaedic Surgery Physician
MD428274
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179031001
—
AR
01
—
5H582
BCBS
AR
Enumeration date
02/14/2008
Last updated
01/27/2014
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