Wallace, John

Wallace, John is an individual health care provider with primary practice located at 1705 Gardner Dr , Wilmington NC 28405-8873. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Wallace, John can be contacted via phone (910) 343-5300.

Contact Information

Primary practice address
1705 Gardner Dr Wilmington NC 28405-8873
Phone: (910) 343-5300
Fax: (910) 254-1352
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 9801546 North Carolina
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 98-01546 North Carolina

Profile Details

NPI number 1457526808
LBN Legal business name Wallace, John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 28th, 2008
Last updated Apr 27th, 2015 - 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 1457526808 NPPES
North Carolina MEDICAID 5920117

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