Individual
FURMAN T WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 BROWN ST, ANDERSON, IN 46016-4218
(765) 649-8161
(765) 641-8274
Mailing address
PO BOX 1258, ANDERSON, IN 46015-1258
(765) 649-8161
(765) 641-8274
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01029302
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100323620
—
IN
Enumeration date
12/06/2006
Last updated
07/08/2007
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