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Individual

JAMES M WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37316
WI
208000000X
Pediatrics Physician
37316
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0413704
MEDICA
01
110168453
RAILROAD
01
27G52WA
BLUE CROSS MN FACILITY
MN
05
32379700
WI
01
64Q42WA
BLUE CROSS MN PRO FEE
MN
05
948017000
MN
01
HP27845
HEALTHPARTNERS
01
NA9031017009
PREFERREDONE
Enumeration date
09/02/2006
Last updated
02/02/2021
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