Individual
DR. PHILIP C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2115 NE WYATT CT., 101, BEND, OR 97701-6324
(541) 323-6280
(541) 323-6288
Mailing address
2115 NE WYATT CT, SUITE 101, BEND, OR 97701-7678
(541) 323-6280
(541) 323-6288
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD152056
OR
208100000X
Physical Medicine & Rehabilitation Physician
P1432
TX
Other
Enumeration date
11/09/2007
Last updated
05/10/2017
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