Individual
MR. GREGORY HALL WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4623 WESLEY AVE, BMF PEDIATRIC CARE SUITE G, NORWOOD, OH 45212
(513) 631-3338
(513) 631-3385
Mailing address
PO BOX 640220, CINCINNATI, OH 45264-0220
(513) 281-8000
(513) 281-5221
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34008036W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2442986
—
OH
Enumeration date
06/15/2006
Last updated
07/08/2007
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