Individual
IRA B WALLACE
Active
Individual
IRA B WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD032125E
PA
207W00000X
Ophthalmology Physician
Primary
MD032125E
PA
Other
Enumeration date
05/25/2006
Last updated
11/23/2010
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