James Doran Wallace, P.A.,D.C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA14039 Issued in CA

Practice address

1650 Lead Hill Blvd
Suite 600
Roseville, CA 95661-3061

Phone

(916) 765-3785

Fax

(916) 361-9869

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242432000000",
    "number": "1013124908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8948 SALMON FALLS DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958261923",
            "telephone_number": "916-765-3785",
            "fax_number": "916-361-9869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 LEAD HILL BLVD",
            "address_2": "SUITE 600",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613061",
            "telephone_number": "916-765-3785",
            "fax_number": "916-361-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMES",
        "middle_name": "DORAN",
        "name_prefix": "Dr.",
        "credential": "P.A.,D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2009-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA14039",
            "primary": true
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "CA",
            "license": "12087",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mailla T Walker
• Michael Walker, N.P.
• Vanessa Jane Walker, DO
• Craig J. Wall, DO
• Ann Wallace, RD, CDCES
• Walls Phlebotomy
• Walmart Inc.
• Walmart Inc.
• Walmart Stores, Inc.
• Walmart, Inc.

• Medical Physician Assistant in Roseville, CA
• Providers in Roseville, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.