Individual
MATTHEW K WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
212 E CENTRAL AVE STE 140, SPOKANE, WA 99208-6289
(509) 465-1300
(509) 465-1313
Mailing address
601 W 5TH AVE STE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
47815
MN
207X00000X
Orthopaedic Surgery Physician
Primary
MD60144423
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2007981
—
WA
05
—
265453900
—
MN
Enumeration date
01/03/2006
Last updated
12/12/2024
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