Individual
DAVID W WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MBA
Contact information
Practice address
515 HOSPITAL DR, SUITE 1, SHELBYVILLE, KY 40065-1640
(502) 633-3525
(502) 633-8075
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 633-3525
(502) 633-8075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048268
ANTHEM
KY
01
—
0100487
UHC
—
05
—
64220544
—
KY
01
—
P00872496
RR MEDICARE
KY
Enumeration date
10/14/2005
Last updated
07/21/2022
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