| Organization Name: | GARY S WALLACH DPM PA |
| NPI Number: | 1013020924 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY S WALLACH (PRESIDENT) |
| Mailing Address: | 2737 E Oakland Park Blvd Ft Lauderdale |
| State: | FL US |
| Postal Code: | 333061641 |
| Phone Number: | 9545613338 |
| Fax Number: | 9545663051 |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 01/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |