Carmel Wallace JR. MD

NPI 1063419000 - Pediatrics - 208000000X

NPI Details
NPI 1063419000
Gender Male
Enumeration Date 07/06/2005
Last Updated 12/18/2015
Entity Type Individual
Active Over 11 years ago
Practice Location
138 LEADER AVE, OFFICE 241
UNIVERSITY OF KENTUCKY, DEPARTMENT OF PEDIATRICS
LEXINGTON KY, 40506-9983, US
Phone (859) 323-1432
Fax (859) 323-3499
Business Location
138 LEADER AVE, OFFICE 241
UNIVERSITY OF KENTUCKY, DEPARTMENT OF PEDIATRICS
LEXINGTON KY, 40506-9983, US
Phone (859) 323-1432
Fax (859) 257-9522
Toxanomy
Taxonomy Code 208000000X
License State Kentucky
License Number 18479
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According to our database, Carmel Wallace JR. MD NPI is 1063419000, taxonomy code is 208000000X and license number is 18479, license state is located at Kentucky. Carmel Wallace JR. MD physically located at 138 Leader Ave, Office 241, Lexington KY, 40506-9983. NPI Number Carmel Wallace JR. MD has the Individual type.

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1063419000 NPI number is provided on an as is basis without warranty of any kind. 1063419000 is maintained by the National Plan & Provider Enumeration System. The contents of Carmel Wallace JR. MD are for informational purposes only.