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1124604061
JACOB WALLACE
SAINT LOUIS, MO
NPI
1124604061
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-03-22
Last Update Date
2021-03-22
Business Address
Dr. JACOB WALLACE MD
6420 CLAYTON RD
SAINT LOUIS, MO 63117-1811
Phone number: 314-768-8000
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Mailing Address
Dr. JACOB WALLACE MD
904 LAMBETH CIR APT 208
DURHAM, NC 27705-4587
Phone number: 989-751-6079
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