Scott C. Wallace, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A115766 Issued in CA

Legal business name

SCOTT C. WALLACE, MD

Practice address

8525 Gibbs Dr
Suite 208
San Diego, CA 92123-1755

Phone

(858) 495-0971

Fax

(858) 495-0991

NPI assigned

May 22, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Scott C Wallace, M.D.NPI 1558381822

Title

President

Phone

(858) 495-0971

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Christopher Wallace, MD

  • Pediatric Anesthesiology Physician
  • Columbus, OH
  • NPI 1558381822
  NPD (past) Authorized official

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1487090098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8525 GIBBS DR",
            "address_2": "SUITE 208",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231755",
            "telephone_number": "858-495-0971",
            "fax_number": "858-495-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8525 GIBBS DR",
            "address_2": "SUITE 208",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231755",
            "telephone_number": "858-495-0971",
            "fax_number": "858-495-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT C. WALLACE, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-495-0971",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A115766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Anthony Scognamillo Jr., DPT ATC CSCS
• Anthony J. Scoma, DDS
• Phaedra Nicole Scoortis, M.A., MFT
• Scooter Store - San Diego LLC
• Scott a. Strommer & Leslie S. Strommer,DDS,Inc.
• Scott Chiropractic LLC
• Scott Cologne MD Inc
• Scott E Musinski, MD, Inc.
• Scott Leary, M.D., Inc.
• Danielle Scott Seach

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; 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.