Individual
THOMAS M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
(209) 576-3525
(209) 576-3544
Mailing address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
(209) 576-3525
(209) 576-3544
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
G42269
CA
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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