MOIRA PETIRS WALLACE

JACKSONVILLE, FL
NPI1053549212
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207P00000X Emergency Medicine
(Licence: FL  ME133941)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: CA  A120516)
Enumeration Date2009-06-26
Last Update Date2023-10-26
Business Address
MOIRA PETIRS WALLACE M.D.
3625 UNIVERSITY BLVD S
JACKSONVILLE, FL 32216-4207
Phone number: 904-702-6111
Mailing Address
MOIRA PETIRS WALLACE M.D.
830-13 A1A NORTH 232
PONTE VEDRA, FL 32082
Phone number: 714-342-3689