Individual
LESTER B. WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1718 E 4TH ST, SUITE 201, CHARLOTTE, NC 28204-3261
(704) 384-0560
(704) 384-0561
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-0560
(704) 384-0561
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21891
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8985506
—
NC
05
—
N21891
—
SC
Enumeration date
07/28/2006
Last updated
02/19/2013
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