Individual
DR. JOHN K WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2664 HARTFORD HWY, DOTHAN, AL 36305-4904
(334) 699-2244
(334) 699-2245
Mailing address
2664 HARTFORD HWY, DOTHAN, AL 36305-4904
(334) 699-2244
(334) 699-2245
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
00013178
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046695
—
AL
Enumeration date
07/03/2006
Last updated
03/22/2010
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