Individual
JERALD PAYDEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 ROSE ST, C246, LEXINGTON, KY 40536-0293
(859) 323-6162
Mailing address
800 ROSE ST, C246, LEXINGTON, KY 40536-0293
(859) 323-6162
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
49437
KY
Other
Enumeration date
05/21/2014
Last updated
07/07/2016
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