| Doctor Name: | MR. RYAN MICHAEL WALLACE |
| NPI Number: | 1003891920 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | HEALTH SERVICES TECH |
| License Number: | B1552861 |
| Business Practice Address: | 5201 Lee Rd Buzzards Bay, MA - 025421313 |
| Business Phone Number: | 5089686572 |
| Business Fax Number: | 5089686581 |
| Mailing Address: | 5425 Carpenter Ave, Apt A BUZZARDS BAY |
| State: | MA |
| Postal Code: | 025421587 |
| Phone Number: | 5089686572 |
| Fax Number: | 5089686581 |
| NPI Enumeration Date: | 12/14/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146N00000X |
| License Number: | B1552861 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Basic |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |