Wallace, Timothy R
Wallace, Timothy R is an individual health care provider with primary practice located at 855 N Westhaven Dr , Oshkosh WI 54904-7668. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, Timothy R can be contacted via phone (920) 303-8700.Contact Information
Primary practice address
855 N Westhaven Dr
Oshkosh WI 54904-7668
Phone: (920) 303-8700
Fax: (920) 303-8832
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 1195 | South Carolina |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | OS013436 | Pennsylvania |
Profile Details
| NPI number | 1275725384 |
|---|---|
| LBN Legal business name | Wallace, Timothy R |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 13th, 2007 |
| Last updated | Dec 6th, 2021 - about 3 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 | 1275725384 | NPPES |
| South Carolina | Other | 1195 | MEDICAL LICENSE |
| South Carolina | Other | 60032-021 | MEDICAL LICENSE |
| South Carolina | Other | OS013436 | MEDICAL LICENSE |
| South Carolina | MEDICAID | 011953 | MEDICAL LICENSE |
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