John Wallace SR., IDC

NPI #1316926066 in Norfolk, Virginia

Provider Information

NPI Number: 1316926066
Entity Type: Individual
Name: John Wallace SR., IDC
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Military Health Care Provider - Independent Duty Corpsman
Credential: IDC
Enumeration Date: Jan 11, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 300 E MAIN ST
Address 2: SUITE 1000
City: Norfolk
State: Virginia
ZIP Code: 23510-1753
Phone: (757) 628-4347

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Military Health Care Provider - Independent Duty Corpsman — Independent Duty Corpsman	1710I1002X	Primary

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