Wallace, Douglas Charles

Wallace, Douglas Charles is an individual health care provider with primary practice located at 3900 St Francis Way Ste 201, Lafayette IN 47905-4923. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Wallace, Douglas Charles can be contacted via phone (765) 446-7981.

Contact Information

Primary practice address
3900 St Francis Way Ste 201 Lafayette IN 47905-4923
Phone: (765) 446-7981
Fax: (765) 446-7982
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X G66727 California
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 036-101410 Illinois
Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) 208G00000X 01071946A Indiana

Profile Details

NPI number 1851470033
LBN Legal business name Wallace, Douglas Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated Dec 19th, 2012 - about 14 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 1851470033 NPPES
Illinois MEDICAID 036112410

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