Individual
DR. RYAN MYLES WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3760 PIPER ST STE 1108, ANCHORAGE, AK 99508-4683
(907) 212-6900
(907) 212-6936
Mailing address
PO BOX 31001-4162, PASADENA, CA 91110-4162
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
158491
AK
2084N0400X
Neurology Physician
55490
CT
2084P0800X
Psychiatry Physician
Primary
158491
AK
2084P0800X
Psychiatry Physician
55490
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004082286
—
CT
05
—
008022626
—
CT
05
—
008056168
—
CT
05
—
008076123
—
CT
05
—
1709157
—
AK
05
—
500000315
—
CT
Enumeration date
09/03/2013
Last updated
12/03/2025
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