Individual
DR. BRUCE ALLEN WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1275 N HIGH ST, HILLSBORO, OH 45133-8273
(614) 393-6100
(614) 293-2809
Mailing address
22165 HEATHERIDGE LN, NORTHVILLE, MI 48167-9300
(314) 401-4941
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02006388A
IN
207P00000X
Emergency Medicine Physician
036171615
IL
207P00000X
Emergency Medicine Physician
34C.000547
OH
207P00000X
Emergency Medicine Physician
Primary
5101025046
MI
Other
Enumeration date
06/13/2017
Last updated
12/30/2025
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