Individual
DR. JAMES C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(136) 038-5220
Mailing address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00028714
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1126WA
REGENCE BLUE SHIELD RIDER
—
05
—
8128357
—
WA
01
—
820000117
RAILROAD MEDICARE
—
Enumeration date
03/10/2006
Last updated
01/30/2023
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