Doctor Name: | DR. DAVID MICHAEL WALLACE |
NPI Number: | 1134285810 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 043144 |
Business Practice Address: | P10500 Mount Bellevedere Drive Attn: Deputy Cdr For Clinical Services (dccs) Fort Drum, NY - 13602 |
Business Phone Number: | 3157724021 |
Business Fax Number: | |
Mailing Address: | 25382 Stewart Dr, CARTHAGE |
State: | NY |
Postal Code: | 136196505 |
Phone Number: | 2542580373 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2006 |
NPI Last Update Date: | 08/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207Q00000X |
License Number: | 043144 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | |
Taxonomy Definition: | Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |