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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457526808 | NPPES |
| North Carolina | MEDICAID | 5920117 |
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