Individual
DR. MATTHEW WILLIAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2815 SOUTH SEACREST BLVD, GME SUITE LOWER LEVEL B, BOYNTON BEACH, FL 33435
(561) 737-7733
(561) 733-0774
Mailing address
2815 S SEACREST BLVD, GME SUITE LOWER LEVEL B, BOYNTON BEACH, FL 33435
(561) 737-7733
(561) 733-0774
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME143324
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME143324
MEDICAL LICENSE
FL
Enumeration date
06/12/2013
Last updated
07/10/2020
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