Individual
AUDREY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2020 SE 17TH ST, OCALA, FL 34471-4118
(352) 732-0277
Mailing address
2020 SE 17TH ST, OCALA, FL 34471-4118
(352) 732-0277
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
33689
AL
2085R0001X
Radiation Oncology Physician
Primary
ME136800
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2013
Last updated
05/16/2025
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