William W Wallace, M.D.

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

G17502 Issued in CA

Practice address

8933 Activity Rd
San Diego, CA 92126-4427

Phone

(858) 653-6170

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144331513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8933 ACTIVITY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264427",
            "telephone_number": "858-653-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8933 ACTIVITY RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921264427",
            "telephone_number": "858-653-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "CA",
            "license": "G17502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G175020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Wallace
• Sarah Neeusha Wallace, MD
• Shannon D Wallace, BCBA
• Sommer Sade' Wallace, M. DIV
• Stephanie Wallace, LMFT
• Carley Claire Wallenburg
• Austin Tanaka Waller
• Edna Waller, M.S.
• Giana Waller
• Victoria Louisa Waller, DC, ATC

• Allergy Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Allergy Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.