John T Wallace II, MD

NPI #1023079803 in Fort Bragg, California

Provider Information

NPI Number: 1023079803
Entity Type: Individual
Name: John T Wallace II, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Internal Medicine
Credential: MD
Enumeration Date: Mar 31, 2006
Last Updated: Dec 22, 2011

Practice Location

Address: 205 SOUTH ST
City: Fort Bragg
State: California
ZIP Code: 95437-5540
Phone: (707) 964-1251

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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