Individual
DR. WALLACE JACK SCHWAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 INDIO DR, PISMO BEACH, CA 93449-1514
(805) 231-8699
Mailing address
PO BOX 1158, SOLVANG, CA 93464-1158
(805) 231-8699
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
GFE12267
CA
Other
Enumeration date
01/30/2013
Last updated
01/30/2013
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