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WILLIAM DAVID WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
Mailing address
PO BOX 23073, JACKSON, MS 39225-3073
(601) 200-6162

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28885
MS

Other

Enumeration date
04/17/2018
Last updated
07/12/2024
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