GREGORY WALLACE, D.O.

Family Medicine

Active Individual
NPI: 1558701250

Practice Address

11050 MOUNT BELVEDERE BLVD
Fort Drum, NY 13602

Phone: (315) 772-5662

Specialties

Specialty Code Primary License
Student in an Organized Health Care Education/Training Program 390200000X No -
Family Medicine 207Q00000X Yes 02004547A (IN)

Frequently Asked Questions

NPI 1558701250 is the National Provider Identifier for GREGORY WALLACE, D.O., a Family Medicine provider located in Fort Drum, NY. This NPI was enumerated on June 27, 2013.
GREGORY WALLACE, D.O. practices at 11050 MOUNT BELVEDERE BLVD, Fort Drum, NY 13602.

Quick Facts

NPI
1558701250
Type
Individual
Enumerated
Jun 27, 2013
Last Updated
Jul 27, 2018

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