DOUGLAS CHARLES WALLACE

LAFAYETTE, IN
NPI1851470033
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery)
(Licence: IN  01071946A)
Additional Taxonomies208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery)
(Licence: CA  G66727)
208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery)
(Licence: IL  036-101410)
Enumeration Date2006-11-06
Last Update Date2012-12-19
Business Address
DR. DOUGLAS CHARLES WALLACE M.D.
3900 ST FRANCIS WAY STE 201
LAFAYETTE, IN 47905-4923
Phone number: 765-446-7981
Mailing Address
DR. DOUGLAS CHARLES WALLACE M.D.
3900 ST FRANCIS WAY STE 201
LAFAYETTE, IN 47905-4923
Phone number: 765-446-7981