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1790017028
BRIAN EDWARD WALLACE
PUYALLUP, WA
NPI
1790017028
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
207L00000X Anesthesiology
(Licence: WA MD 60120035)
Enumeration Date
2010-02-11
Last Update Date
2016-07-11
Business Address
Dr. BRIAN EDWARD WALLACE M.D.
400 E PIONEER AVE SUITE 101
PUYALLUP, WA 98372-3255
Phone number: 253-445-5828
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Mailing Address
Dr. BRIAN EDWARD WALLACE M.D.
400 E PIONEER AVE SUITE 101
PUYALLUP, WA 98372-3255
Phone number: 253-445-5828
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