Individual
WILLIAM C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 MEDICAL CENTER DR, SUITE G500, HUNTINGTON, WV 25701-3656
(304) 691-1262
Mailing address
1600 MEDICAL CENTER DR, SUITE G500, HUNTINGTON, WV 25701-3656
(304) 691-1262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21450
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2583128
—
OH
05
—
3810000190
—
WV
05
—
64082704
—
KY
Enumeration date
03/23/2006
Last updated
11/17/2021
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