Wallace, Douglas C
Wallace, Douglas C is an individual health care provider with primary practice located at 4072 Gantz Rd , Grove City OH 43123-4816. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, Douglas C can be contacted via phone (614) 875-0011.Contact Information
Primary practice address
4072 Gantz Rd
Grove City OH 43123-4816
Phone: (614) 875-0011
Fax: (614) 539-7287
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 35.049780 | Ohio |
Profile Details
| NPI number | 1063451144 |
|---|---|
| LBN Legal business name | Wallace, Douglas C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 5th, 2006 |
| Last updated | Jul 21st, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063451144 | NPPES |
| Ohio | MEDICAID | 0586996 |
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