DR. Gary Wayne Wallace, M.D.

NPI #1144335290 in Idaho Falls, Idaho

Provider Information

NPI Number: 1144335290
Entity Type: Individual
Name: DR. Gary Wayne Wallace, M.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Ophthalmology
Credential: M.D.
Enumeration Date: Aug 20, 2006
Last Updated: May 26, 2011

Practice Location

Address: 2295 CORONADO STREET
City: Idaho Falls
State: Idaho
ZIP Code: 83404
Phone: (208) 524-8600

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Ophthalmology	207W00000X	Primary

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