Wallace, Aaron Jack

Wallace, Aaron Jack is an individual health care provider with primary practice located at 4802 E Johnson Ave , Jonesboro AR 72401-6007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Wallace, Aaron Jack can be contacted via phone (870) 936-8523.

Contact Information

Primary practice address
4802 E Johnson Ave Jonesboro AR 72401-6007
Phone: (870) 936-8523
Fax: (870) 934-3633
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD428274 Pennsylvania
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X E-6150 Arkansas

Profile Details

NPI number 1275701963
LBN Legal business name Wallace, Aaron Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2008
Last updated Jan 27th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275701963 NPPES
Arkansas MEDICAID 179031001
Arkansas Other 5H582

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