DR. DAVID R WALLACE JR. (NPI# 1265743595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265743595 |
| Entity Type | Individual |
| Full Name | DR. DAVID R WALLACE JR. |
| Credential | M.D. |
| Practice Address |
200 W Arbor Dr # Mc0834 Department of Radiology San Diego CA 92102-0834 |
| Mailing Address |
200 W Arbor Dr # Mc0834 Department of Radiology San Diego CA 92103-0834 |
| Practice Telephone | 1619543622 |
| Mailing Telephone | 1619543622 |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2015-06-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD.204718 | LA | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
A136122 | CA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700327061 | David Wallace | Student in an Organized Health Care Education/Training Program | 24606 Mosquero Ln, Mission Viejo, CA 92691-4913 | 2017-03-19 |
| 1386868487 | David Stuart Wallace | Chiropractor | 2330 Highway 94 South Outer Rd, Saint Charles, MO 63303-8301 | 2007-04-12 |
| 1649343641 | David Michael Wallace | Chiropractor | 112 W Grand Ave, Rainbow City, AL 35906-3233 | 2006-11-16 |
| 1932193604 | David Wallace | Anesthesiology | 738 Golden Pheasant Dr, Draper, UT 84020-8454 | 2005-09-08 |
| 1386646206 | David Allen Wallace | Dentist | 206 S Walker St, Princeton, WV 24740-2747 | 2005-08-11 |
| 1295736809 | David B. Wallace | Radiology | 325 N Highland Ave, Provena Mercy Medical Center, Aurora, IL 60506-3811 | 2005-08-04 |
| 1679576276 | David Alan Wallace | Ophthalmology | 11600 Wilshire Blvd, Ste 200, Los Angeles, CA 90025-1782 | 2005-05-27 |
| 1619596335 | David Alexander Wallace | Student in an Organized Health Care Education/Training Program | 920 Madison Ave Ste 447, Memphis, TN 38103-3438 | 2020-04-13 |
| 1396364402 | David Carter Wallace | Student in an Organized Health Care Education/Training Program | 620 Shadow Ln, Las Vegas, NV 89106-4119 | 2020-04-09 |
| 1720646672 | David Wallace | Physician Assistant | 1 Hospital Plz, Stamford, CT 06902-3602 | 2019-06-04 |
| Street Address |
200 W ARBOR DR # MC0834 DEPARTMENT OF RADIOLOGY |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92102-0834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437766698 | Daniela Tablas | Behavioral Analyst | 303 47th St Spc D-22, San Diego, CA 92102 | 2020-09-30 |
| 1649745712 | Juliet Lao Kurek | Pharmacist | 2121 Imperial Avenue, San Diego, CA 92102 | 2018-10-04 |
| 1851887020 | Monique Joseph | Counselor | 2410 E. Street, San Diego, CA 92102 | 2018-07-10 |
| 1184166316 | Elise Blanton-hubbard | Counselor | 1850 Dale St, San Diego, CA 92102 | 2016-11-04 |
| 1699221416 | Kari Judith Medina | Student in an Organized Health Care Education/Training Program | 1199 34th Street Apt 11, San Diego, CA 92102 | 2016-08-31 |
| 1942674536 | Caitlin Hillary Dablow | Speech-Language Pathologist | 1201 34th Street, San Diego, CA 92102 | 2015-11-19 |
| 1134508179 | Jonathan Waters | Military Health Care Provider | 1233 22nd Street, Unit 8, San Diego, CA 92102 | 2015-05-22 |
| 1871989913 | Abraham Greenberg | Pediatrics | 15 Balfour Street, Jerusalem, ISRAEL 92102 | 2015-04-15 |
| 1023421021 | Elmira Aghdam | Chiropractor | 5030 Bonita Rd Ste#b, Bonita, CA 92102 | 2014-06-06 |
| 1487092540 | Sherry Scott | Marriage & Family Therapist | 995 Gateway Center Drive #300, San Diego, CA 92102 | 2013-06-11 |
| Find all providers in zip 92102 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790208155 | St. Jude Radiology Medical Group, Inc. | Radiology | 8070 Entrada De Luz E, San Diego, CA 92127-2561 | 2017-07-18 |
| 1225586423 | Regional Diagnostic Imaging | Radiology | 3731 Torrey View Ct, San Diego, CA 92130-2623 | 2016-09-15 |
| 1093127680 | William James Tom | Radiology | 200 West Arbor Drive, Mc 0834, San Diego, CA 92103-0834 | 2014-05-30 |
| 1649697947 | Ashley Caitlin Altman | Radiology | Uc San Diego Health, 200 West Arbor Drive, Mc 8829, San Diego, CA 92103 | 2014-03-25 |
| 1477811693 | Michele Christina Mcgahan | Radiology | 8745 Aero Drive #200, San Diego, CA 92193-3540 | 2012-04-25 |
| 1447557996 | Luke R Scalcione | Radiology | 7540 Charmant Dr, Apt 1216, San Diego, CA 92122-5044 | 2011-02-18 |
| 1144537606 | Jasmine Jamin Koo | Radiology | 5330 Carroll Canyon Rd Ste 140, San Diego, CA 92121-3758 | 2010-09-04 |
| 1881837748 | John Joseph Krol | Radiology | 11125 Red Cedar Dr, San Diego, CA 92131-1309 | 2009-04-08 |
| 1700022712 | Thomas N. Folan | Radiology | 425 W Beech St Unit 1707, San Diego, CA 92101-2965 | 2008-12-22 |
| 1740445121 | Patrick Ryan Henderson | Radiology | 410 Dickinson St, San Diego, CA 92103-6902 | 2008-07-24 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.