Individual
DR. DANA V WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2699 STIRLING RD STE B305, FT LAUDERDALE, FL 33312-6546
(954) 981-9180
(954) 961-4752
Mailing address
11880 SW 40TH ST, SUITE 304, MIAMI, FL 33175-3584
(305) 223-8808
(305) 223-8974
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
ME0025502
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006256200
—
FL
01
—
93292X
MEDICARE
FL
Enumeration date
06/14/2006
Last updated
07/21/2022
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