Individual
STEPHEN A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2741 S 8TH AVE, SUITE C, YUMA, AZ 85364-7154
(928) 726-0985
Mailing address
SUITE C, 2741 S 8TH AVE, YUMA, AZ 85364-7154
(928) 726-0985
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
13856
AZ
Other
Enumeration date
08/18/2005
Last updated
11/17/2009
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