MR. Jared Lee Wallace, PA-C

NPI #1063746667 in Kenai, Alaska

Provider Information

NPI Number: 1063746667
Entity Type: Individual
Name: MR. Jared Lee Wallace, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Sep 29, 2009
Last Updated: Mar 7, 2023

Practice Location

Address: 43783 KENAI SPUR HWY
City: Kenai
State: Alaska
ZIP Code: 99611
Phone: (907) 283-9116

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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