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NPI Code Detail

MEDICARE: DR. WALLACE REID GIEDT, JR. MD

MEDICARE: DR. WALLACE REID GIEDT, JR. 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
1208000000XPediatrics PhysicianG46831CA

General Provider Information

NPI Number : 1811949993
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALLACE REID GIEDT, JR. MD
Provider Business Mailing Address
First Line : 100 WILSON RD STE 100
Second Line :
City : MONTEREY
State : CA
Zip : 93940-7885
Country : US
Telephone Number : 831-242-8645
Fax Number :
Provider Business Practice Location Address
First Line : 355 ABBOTT ST STE 100
Second Line :
City : SALINAS
State : CA
Zip : 93901-4484
Country : US
Telephone Number : 831-751-7070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 05/02/2025

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