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General NPI Number Information
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NPI Number | 1376660241
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Entity Type | Organization
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Legal Business Name | STEVEN B WALLACH DO
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3005 W INA RD SUITE 123
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City | TUCSON
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State | AZ
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Zip | 85741-2107
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Country | US
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Telephone | 520-575-9110
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Fax | 520-575-8033
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Provider Business Mailing Address
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Address Line | 3005 W INA RD SUITE 123
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City | TUCSON
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State | AZ
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Zip | 85741-2107
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Country | US
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Telephone | 520-575-9110
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Fax | 520-575-8033
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | STEVEN B WALLACH
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Credential | DO
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Telephone | 520-575-9110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2113
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License Number State | AZ
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