Individual
DR. WALLACE I LAI I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8380
(503) 371-1756
(503) 584-7971
Mailing address
2480 LIBERTY ST NE, SUITE 110, SALEM, OR 97301-8380
(503) 371-1756
(503) 584-7971
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD17813
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060060218
RAILROAD MEDICARE
OR
05
—
100009591
—
OR
05
—
288256
—
OR
Enumeration date
06/08/2006
Last updated
09/01/2015
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