Individual
ATO WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 232-6162
Mailing address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-6162
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
KY
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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