Individual
WILLIAM R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 6TH ST SW, RADIOLOGY ASSOCIATES OF CANTON, INC, CANTON, OH 44710-1702
(330) 363-2842
(330) 580-5536
Mailing address
P.O. BOX 72384, RADIOLOGY ASSOCIATES OF CANTON, INC., CLEVELAND, OH 44192
(888) 686-1837
(330) 686-5928
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
35 044677
OH
2085R0202X
Diagnostic Radiology Physician
Primary
35 044677
OH
2085U0001X
Diagnostic Ultrasound Physician
35 044677
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0558178
—
OH
01
—
P00417325
RAILROAD MEDICARE
OH
Enumeration date
12/01/2005
Last updated
01/05/2011
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