Individual
MR. BRUCE A WALLSTEDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6323 CANTERBURY CLOSE, BRENTWOOD, TN 37027-4870
(615) 504-9479
(615) 730-7334
Mailing address
6323 CANTERBURY CLOSE, BRENTWOOD, TN 37027-4870
(615) 504-9479
(615) 730-7334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD25914
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3086317
—
TN
Enumeration date
09/14/2005
Last updated
03/17/2010
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