Wallace, Kenneth A

Wallace, Kenneth A is an individual health care provider with primary practice located at 1091 Se 59Th St , Ocala FL 34480-6146. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Wallace, Kenneth A can be contacted via phone (850) 597-0324.

Contact Information

Primary practice address
1091 Se 59Th St Ocala FL 34480-6146
Phone: (850) 597-0324
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X ME73625 Florida
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X ME73625 Florida
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X ME73625 Florida

Profile Details

NPI number 1295791754
LBN Legal business name Wallace, Kenneth A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Apr 2nd, 2020 - about 4 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 1295791754 NPPES
Florida MEDICAID 000651600

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