MEDICARE: DR. WALLACE J ESPER DO

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
1	207Q00000X	Family Medicine Physician	OS008755L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992709489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALLACE J ESPER DO

Provider Business Mailing Address
First Line	:	3435 W LAKE RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3661
Country	:	US
Telephone Number	:	814-438-3854
Fax Number	:	814-438-2253

Provider Business Practice Location Address
First Line	:	3435 W LAKE RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3661
Country	:	US
Telephone Number	:	814-438-3854
Fax Number	:	814-438-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/01/2021

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Directions to “ DR. WALLACE J ESPER DO” Practice Location

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