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Donald R. Wallace, MD
Emergency Medicine Physician in Peoria, Illinois
NPI 1700899788

Donald R. Wallace is a Emergency Medicine Physician based in Peoria, IL. Donald R. Wallace practices in Peoria, IL and has the professional credentials of MD. The NPI Number for Donald R. Wallace is 1700899788 and holds a License No. 036-077680 (Illinois).

The current practice location address for Donald R. Wallace is 5114 N Glen Park Place Rd, Peoria, IL and can be reached out via phone at 309-683-6600.

Location: 5114 N Glen Park Place Rd, Peoria, IL, 61614-4686
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700899788
Provider Name
Donald R. Wallace
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
5114 N Glen Park Place Rd, Peoria, IL, 61614-4686
Phone Number
309-683-6600
Fax Number
Provider Enumeration Date
08/14/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
036077680 05 IL
809840034 01 IL MEDICARE INDIVIDUAL PTAN
800810 01 MEDICARE GROUP NO.
809840 01 IL MEDICARE GROUP PTAN
institution
Provider Business Practice Location Address Details
Address
5114 N Glen Park Place Rd
City
Peoria
State
Illinois
Zip
61614-4686
Phone Number
309-683-6600
Fax Number
person
Provider Business Mailing Address Details
Address
5114 N Glen Park Place Rd
City
Peoria
State
Illinois
Zip
61614-4686
Phone Number
309-683-6600
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Emergency Medicine
Speciality
-
Taxonomy
207P00000X
License No.
036-077680 (Illinois)
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
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