Emmett Lee Wallace, DO

NPI #1215992334 in Bettendorf, Iowa

Provider Information

NPI Number: 1215992334
Entity Type: Individual
Name: Emmett Lee Wallace, DO
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Family Medicine
Credential: DO
Enumeration Date: Apr 20, 2006
Last Updated: Jul 22, 2011

Practice Location

Address: 1019 BROADLAWN AVENUE
City: Bettendorf
State: Iowa
ZIP Code: 52722
Phone: (563) 359-1181

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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