Individual
JACOB WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 W IRON AVE FL 5, SALINA, KS 67401-2600
(785) 827-9526
(785) 827-2854
Mailing address
119 W IRON AVE FL 5, SALINA, KS 67401-2600
(785) 827-9526
(785) 827-2854
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
94-08609
KS
2085R0202X
Diagnostic Radiology Physician
Primary
04-44613
KS
Other
Enumeration date
06/17/2015
Last updated
03/10/2025
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