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Alec Nathaniel Wallace, DO
Military Health Care Provider in Travis Afb, California
NPI 1487242087

Alec Nathaniel Wallace is a Military Health Care Provider based in Travis Afb, CA. Alec Nathaniel Wallace practices in Travis Afb, CA and has the professional credentials of DO. The NPI Number for Alec Nathaniel Wallace is 1487242087 and holds a License No. (California).

The current practice location address for Alec Nathaniel Wallace is 101 Bodin Cir, Travis Afb, CA and can be reached out via phone at 707-423-3000.

Location: 101 Bodin Cir, Travis Afb, CA, 94535-1809
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1487242087
Provider Name
Alec Nathaniel Wallace
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
101 Bodin Cir, Travis Afb, CA, 94535-1809
Phone Number
707-423-3000
Fax Number
Provider Enumeration Date
01/08/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
101 Bodin Cir
City
Travis Afb
State
California
Zip
94535-1809
Phone Number
707-423-3000
Fax Number
person
Provider Business Mailing Address Details
Address
101 Bodin Cir
City
Travis Afb
State
California
Zip
94535-1809
Phone Number
707-423-3000
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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