Individual
MCKENZIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
M263 MEDICAL SCIENCE BUILDING ONE HOSPITAL DRIVE, COLUMBIA, MO 65212-0001
(573) 882-3014
Mailing address
M263 MEDICAL SCIENCE BUILDING ONE HOSPITAL DRIVE, COLUMBIA, MO 65212-0001
(573) 882-3014
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2024023604
MO
Other
Enumeration date
05/16/2024
Last updated
06/24/2024
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