Douglas W Wallace (NPI# 1376698753, PAC ID# 3274621545) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is MAXILLOFACIAL SURGERY.
| Nation Provider ID (NPI) | 1376698753 |
| PAC ID by PECOS | 3274621545 |
| Professional Enrollment ID | I20161227002025 |
| Full Name | Douglas W Wallace |
| Organization Legal Name | AFFILIATES IN ORAL AND MAXILLOFACIAL SURGERY INC |
| Address |
5188 Winton Rd Fairfield OH 45014-2900 |
| Phone Number | 5138298080 |
| Gender | M |
| Medical School | OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY |
| Graduation Year | 1981 |
| Primary Specialty | MAXILLOFACIAL SURGERY |
| Secondary Specialties | ORAL SURGERY |
| Group Practice PAC ID | 4981637386 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 5188 Winton Rd, Fairfield, OH 45014-2900 | 5138298080 | AFFILIATES IN ORAL AND MAXILLOFACIAL SURGERY INC |
| Organization Legal Name | AFFILIATES IN ORAL AND MAXILLOFACIAL SURGERY INC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy W Conley | Maxillofacial Surgery | Affiliates In Oral and Maxillofacial Surgery Inc | 5188 Winton Rd, Fairfield, OH 45014-2900 |
| Christopher A Mcdaniel | Maxillofacial Surgery | Affiliates In Oral and Maxillofacial Surgery Inc | 5188 Winton Rd, Fairfield, OH 45014-2900 |
| Street Address |
5188 WINTON RD |
| City | FAIRFIELD |
| State | OH |
| Zip | 45014-2900 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Timothy W Conley | Maxillofacial Surgery | Affiliates In Oral and Maxillofacial Surgery Inc | 5188 Winton Rd, Fairfield, OH 45014-2900 |
| Christopher A Mcdaniel | Maxillofacial Surgery | Affiliates In Oral and Maxillofacial Surgery Inc | 5188 Winton Rd, Fairfield, OH 45014-2900 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Richard Sterling Jackson | Optometry | 574 Symmes Rd, Fairfield, OH 45014-1038 | |
| Amir Izhar | Nephrology | Kidney and Hypertension Center Inc | 1210 Hicks Blvd, Fairfield, OH 45014-1921 |
| Diana Christine Scott | Certified Clinical Nurse Specialist (cns) | Decoach Team LLC | 6570 Sosna Dr, Fairfield, OH 45014-2222 |
| James R Hodge | Colorectal Surgery (proctology) | Decoach Team LLC | 6570 Sosna Dr, Fairfield, OH 45014-2222 |
| Robert D Poteete | Chiropractic | 5088 Pleasant Ave, Fairfield, OH 45014-2518 | |
| Karl W Jackson | Psychologist, Clinical | 311 Nilles Rd A, Fairfield, OH 45014-2621 | |
| Dummi P Yathiraj | Internal Medicine | 311 Nilles Rd C, Fairfield, OH 45014-2621 | |
| Rahib N Vasi | Internal Medicine | 311 Nilles Rd, Suite C, Fairfield, OH 45014-2621 | |
| Shwetal Desai | Internal Medicine | 5157 Pleasant Ave, Fairfield, OH 45014-2622 | |
| Mahendra K Matta | Colorectal Surgery (proctology) | 447 Nilles Rd, Suite 3, Fairfield, OH 45014-2626 | |
| Find all physicians in zip 45014 | |||
| City | FAIRFIELD |
| Zip Code | 45014 |
| Specialty | MAXILLOFACIAL SURGERY |
| City + Specialty | FAIRFIELD + MAXILLOFACIAL SURGERY |
Please comment or provide details below to improve the information on Douglas W Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.