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Contact Information

JEFFREY L WALLACE, MD
411 N SECTION ST
FAIRHOPE, AL36532-2649
 Phone: 251-928-9090
 Fax: 251-990-0520
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Undersea and Hyperbaric Medicine

2083P0011X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for JEFFREY L WALLACE · (Male)

NPI # 1548262108
Status Active
Credentials MD
Entity Individual
Enumeration date 08/12/2005
Last updated 10/10/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • AL License # 29105
  • AL License # MD29105
  • AL Medicaid 1407812001
  • AL Medicaid 1548262108
  • TN Medicaid 3-187746
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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