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NPI Code Detail

MEDICARE: DR. JAMES C WALLACE MD

MEDICARE: DR. JAMES C WALLACE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianMD00028714WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3820000117OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21126WAOTHERREGENCE BLUE SHIELD RIDER

General Provider Information

NPI Number : 1801864327
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES C WALLACE MD
Provider Business Mailing Address
First Line : 834 SHERIDAN ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2443
Country : US
Telephone Number : 360-385-2200
Fax Number :
Provider Business Practice Location Address
First Line : 834 SHERIDAN ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2443
Country : US
Telephone Number : 136-038-5220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 01/30/2023

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