GREGORY WALLACE, D.O.
Family Medicine
Active
Individual
NPI: 1558701250
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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