Individual
DR. PERRY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 5TH ST, SUITE 202, MERIDIAN, MS 39301-5108
(601) 286-3410
(601) 286-3425
Mailing address
4156 A PL, MERIDIAN, MS 39301-1037
(662) 402-0608
(601) 286-3425
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
10491
MS
207P00000X
Emergency Medicine Physician
29610
TN
207R00000X
Internal Medicine Physician
10491
MS
207R00000X
Internal Medicine Physician
Primary
13895
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3331790
—
TN
05
—
417498226A
—
GA
Enumeration date
06/21/2006
Last updated
11/14/2011
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