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General NPI Number Information
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NPI Number | 1114960879
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Entity Type | Organization
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Legal Business Name | DANA V WALLACE MD PA
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2699 STIRLING ROAD SUITE B305
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City | FT LAUDERDALE
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State | FL
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Zip | 33312
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Country | US
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Telephone | 954-963-5363
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Fax | 954-963-7099
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Provider Business Mailing Address
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Address Line | 2699 STIRLING ROAD SUITE B305
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City | FT LAUDERDALE
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State | FL
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Zip | 33312
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Country | US
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Telephone | 954-963-5363
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Fax | 954-963-7099
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANA V WALLACE
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Credential | MD
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Telephone | 954-963-5363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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