Individual
MR. JOHN DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 BRIDGE ST, EAST JORDAN, MI 49727-9383
(231) 536-2206
(231) 536-7150
Mailing address
601 BRIDGE ST, EAST JORDAN, MI 49727-9383
(231) 536-2206
(231) 536-7150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006422
MI
Other
Enumeration date
07/15/2012
Last updated
09/20/2022
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