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Individual

ERIC WALLACE

Active
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Individual

ERIC WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A85195
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A851950
BLUESHIELD OF CA
CA
05
00A851950
CA
Enumeration date
06/06/2006
Last updated
11/14/2017
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If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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