Grant Charles Wallace M.D.

NPI 1043208101 - Radiology - 2085R0202X

NPI Details
NPI 1043208101
Gender Male
Enumeration Date 10/12/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
10651 E ST
NAVAL HOSPITAL CORPUS CHRISTI
CORPUS CHRISTI TX, 78419-5130, US
Phone (361) 961-3466
Fax
Business Location
13745 CAYO GORDA CT
CORPUS CHRISTI TX, 78418-6301, US
Phone (361) 949-0264
Fax
Toxanomy
Taxonomy Code 2085R0202X
License State California
License Number G80310
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According to our database, Dr. Grant Charles Wallace M.D. NPI is 1043208101, taxonomy code is 2085R0202X and license number is G80310, license state is located at California. Grant Charles Wallace M.D. physically located at 10651 E St, Corpus Christi TX, 78419-5130. NPI Number Grant Charles Wallace M.D. has the Individual type.

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1043208101 NPI number is provided on an as is basis without warranty of any kind. 1043208101 is maintained by the National Plan & Provider Enumeration System. The contents of Grant Charles Wallace M.D. are for informational purposes only.