Individual
DR. ADAM JOSEPH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3336 E 32ND ST STE 220, TULSA, OK 74135-4442
(918) 255-7246
(918) 255-7000
Mailing address
6802 S OLYMPIA AVE, SUITE 100, TULSA, OK 74132-1823
(918) 447-9300
(918) 447-9308
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
26497
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200222690A
—
OK
Enumeration date
06/29/2008
Last updated
04/29/2019
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