Individual
DR. JAMES MICHAEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1528 LAIRD AVE, SALT LAKE CITY, UT 84105-1730
(503) 475-8549
Mailing address
821 S 600 E, SALT LAKE CITY, UT 84102-3507
(503) 475-8549
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
7471598-1205
UT
207P00000X
Emergency Medicine Physician
Primary
MD60247504
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD13915
MEDICAL LICENSE
RI
Enumeration date
11/14/2008
Last updated
10/23/2024
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