Wallace, John Gray
Wallace, John Gray is an individual health care provider with primary practice located at 332 Highway 12 W , Kosciusko MS 39090-3209. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, John Gray can be contacted via phone (662) 289-1800.Contact Information
Primary practice address
332 Highway 12 W
Kosciusko MS 39090-3209
Phone: (662) 289-1800
Fax: (662) 289-2486
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 22522 | Mississippi |
Profile Details
| NPI number | 1831486596 |
|---|---|
| LBN Legal business name | Wallace, John Gray |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2011 |
| Last updated | Sep 22nd, 2014 - about 11 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 | 1831486596 | NPPES |
| Mississippi | MEDICAID | 07830815 |
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