John T Wallace Ii, MD | |
205 South St, Fort Bragg, CA 95437-5540 | |
(707) 964-1251 | |
(707) 961-2722 |
Full Name | John T Wallace Ii |
---|---|
Gender | Male |
Speciality | Internal Medicine |
Location | 205 South St, Fort Bragg, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1023079803 | NPI | - | NPPES |
00G377730 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | G37773 (California) | Primary |
Entity Name | Aretaeus Telemedicine Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1548490261 PECOS PAC ID: 6002953635 Enrollment ID: O20091029000684 |
Mailing Address | Practice Location Address |
---|---|
John T Wallace Ii, MD 205 South St, Fort Bragg, CA 95437-5540 Ph: (707) 964-1251 | John T Wallace Ii, MD 205 South St, Fort Bragg, CA 95437-5540 Ph: (707) 964-1251 |
Dr. James William Swallow, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-961-4631 Fax: 707-964-1192 | |
Jason Kirkman, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-961-4631 Fax: 707-964-1192 | |
John Arthur Rochat, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 700 River Dr, Fort Bragg, CA 95437 Phone: 707-961-4922 Fax: 707-961-4900 | |
Elizabeth Allan Khan, Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-961-4631 Fax: 707-964-1192 | |
Richard Sacks-wilner, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 721 River Drive, Suite A, Fort Bragg, CA 95437 Phone: 707-964-7241 |