Wallace, Jeffrey Leigh

Wallace, Jeffrey Leigh is an individual health care provider with primary practice located at 411 N Section St , Fairhope AL 36532-2649. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine, Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Wallace, Jeffrey Leigh can be contacted via phone (251) 928-9090.

Contact Information

Primary practice address
411 N Section St Fairhope AL 36532-2649
Phone: (251) 928-9090
Fax: (251) 990-0520
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine 2083P0011X 29105 Alabama
Allopathic & Osteopathic Physicians / Surgery 208600000X 29105 Alabama
Allopathic & Osteopathic Physicians / General Practice 208D00000X MD29105 Alabama

Profile Details

NPI number 1548262108
LBN Legal business name Wallace, Jeffrey Leigh
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Oct 10th, 2016 - about 9 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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Identifiers

StateTypeNumberIssuer
All States NPI 1548262108 NPPES
Alabama MEDICAID 1407812001
Alabama MEDICAID 1548262108
Alabama MEDICAID 3-187746

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