Graham Wilson Wallace MD

NPI 1063499267 - Family Medicine - 207Q00000X

NPI Details
NPI 1063499267
Gender Male
Enumeration Date 12/29/2005
Last Updated 07/17/2013
Entity Type Individual
Active Over 11 years ago
Practice Location
RAF LAKENHEATH 48 MDG/SGCR
UNIT 5210 BOX 230
APO AE, 09461-0230, US
Phone 011441638528124
Fax
Business Location
RAF LAKENHEATH 48 MDG/SGCR
UNIT 5210 BOX 230
APO AE, 09461-0230, US
Phone 011441638528124
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Indiana
License Number 01051128A
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According to our database, Dr. Graham Wilson Wallace MD NPI is 1063499267, taxonomy code is 207Q00000X and license number is 01051128A, license state is located at Indiana. Graham Wilson Wallace MD physically located at Raf Lakenheath 48 Mdg/sgcr, Apo AE, 09461-0230. NPI Number Graham Wilson Wallace MD has the Individual type.

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1063499267 NPI number is provided on an as is basis without warranty of any kind. 1063499267 is maintained by the National Plan & Provider Enumeration System. The contents of Graham Wilson Wallace MD are for informational purposes only.