Individual
DR. WALLACE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 MEMORIAL MEDICAL PKWY STE 307, DAYTONA BEACH, FL 32117-5169
(386) 231-4351
(386) 231-3517
Mailing address
10936 NW 41ST DR, CORAL SPRINGS, FL 33065-7762
(561) 201-3234
(320) 238-7353
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
308521
NY
207R00000X
Internal Medicine Physician
ME126338
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME126338
FL
208M00000X
Hospitalist Physician
ME126338
AL
208M00000X
Hospitalist Physician
ME126338
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018564000
—
FL
Enumeration date
11/12/2010
Last updated
08/06/2025
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