Individual
MARK R. WALLACE
Active
Individual
MARK R. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD00020591
WA
207RI0200X
Infectious Disease Physician
ME94199
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2039554
—
WA
05
—
275105400
—
FL
Enumeration date
01/11/2006
Last updated
02/28/2017
Update your record
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