| Doctor Name: | DR. WILLIAM ARTHUR WALLACE |
| NPI Number: | 1184842627 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 35.079632 |
| Business Practice Address: | 1679 Eagle Harbor Pkwy Suite C Fleming Island, FL - 320034815 |
| Business Phone Number: | 9043480727 |
| Business Fax Number: | 9046219272 |
| Mailing Address: | 1679 Eagle Harbor Pkwy, Suite C FLEMING ISLAND |
| State: | FL |
| Postal Code: | 320034815 |
| Phone Number: | 9043480727 |
| Fax Number: | 9046219272 |
| NPI Enumeration Date: | 04/22/2007 |
| NPI Last Update Date: | 11/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | 35.079632 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |