Wallace, Graham Wilson

Wallace, Graham Wilson is an individual health care provider with primary practice located at David Grant Medical Center 101 Bodin Circle, Travis Afb CA 94535-1809. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Wallace, Graham Wilson can be contacted via phone (707) 423-3040.

Contact Information

Primary practice address
David Grant Medical Center 101 Bodin Circle Travis Afb CA 94535-1809
Phone: (707) 423-3040
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01051128A Indiana
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 01051128A Indiana
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X C142217 California

Profile Details

NPI number 1063499267
LBN Legal business name Wallace, Graham Wilson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Mar 4th, 2022 - about 3 years ago

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.

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