Individual
ALEC NATHANIEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-3000
Mailing address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
208D00000X
General Practice Physician
Primary
02008162A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/08/2021
Last updated
01/21/2026
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