Individual
JAMES JOHN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
360 E EH CRUMP BLVD, MEMPHIS, TN 38126-5394
(901) 261-2000
(901) 946-9262
Mailing address
360 E EH CRUMP BLVD, MEMPHIS, TN 38126-5394
(901) 261-2000
(901) 946-9262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28115-021
WI
207Q00000X
Family Medicine Physician
Primary
5182
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30027800
—
WI
01
—
5182
LICENSE
TN
01
—
P00983439
RAILROAD MEDICARE
WI
Enumeration date
06/26/2006
Last updated
07/26/2024
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