Individual
STEPHEN J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4103 MERCANTILE DR, LAKE OSWEGO, OR 97035-2556
(503) 850-9940
(503) 850-6709
Mailing address
4103 MERCANTILE DR, LAKE OSWEGO, OR 97035-2556
(503) 850-9940
(503) 850-6709
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD206048
OR
207X00000X
Orthopaedic Surgery Physician
MD60932486
WA
207XX0801X
Orthopaedic Trauma Physician
Primary
MD206048
OR
207XX0801X
Orthopaedic Trauma Physician
MD60932486
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396162673
—
WA
Enumeration date
03/24/2014
Last updated
01/08/2026
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