Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. RICHARD JEREMY WALLACE, PA-C
ActiveMR. RICHARD JEREMY WALLACE, PA-C is a Physician Assistant healthcare provider located in WILLISTON, South Carolina. NPI 1841583788 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · WILLISTON, SC
Registration Details
- NPI Number
- 1841583788
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 25, 2011 (15.210562938945 yrs)
- Last Updated
- Jan 11, 2024
Practice Information
- Address
-
13649 CHURCH STREETWILLISTON, SC, 29853Browse SC providers · Browse ZIP 29853
- Phone
- 8032660060
- Fax
- 8032660042
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in WILLISTON, SC
| Name | Credential | NPI |
|---|---|---|
| VICKIE GLOVER | PA | 1386668648 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.