Individual
JODI BETH WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
725 IRVING AVE, STE 600, SYRACUSE, NY 13210-1603
(315) 464-5162
(315) 464-4613
Mailing address
725 IRVING AVE, STE 600, SYRACUSE, NY 13210-1603
(315) 464-5162
(315) 464-4613
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
271804
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03657994
—
NY
Enumeration date
02/01/2009
Last updated
11/14/2013
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