| NPI | 1063176352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN J WALLACE Md 270-556-0604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2021-10-24 |
| Last Update Date | 2026-01-08 |