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General NPI Number Information
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NPI Number | 1386393551
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Entity Type | Individual
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Provider Name | CHRISTOPHER JACOB WALLACE MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 300 HOSPITAL PKWY
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City | MOUNT VERNON
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State | WA
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Zip | 98274-2100
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Country | US
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Telephone | 360-424-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 SW 1ST AVE
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City | OCALA
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State | FL
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Zip | 34471-6500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD.MD.61629334
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License Number State | WA
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