Individual
WAYNE O WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
810 RAVEN HILL DRIVE, ATCHISON, KS 66002-1401
(913) 367-6689
(913) 360-5837
Mailing address
810 RAVEN HILL DRIVE, ATCHISON, KS 66002-1243
(913) 367-7300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0413701
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098780I
—
KS
Enumeration date
06/28/2005
Last updated
01/28/2010
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