Provider Demographics
NPI:1811181498
Name:WALLACE, DOUGLAS CECIL (PHD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CECIL
Last Name:WALLACE
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:2014 HEWITT HALL
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-3940
Mailing Address - Country:US
Mailing Address - Phone:949-824-3490
Mailing Address - Fax:
Practice Address - Street 1:2014 HEWITT HALL
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA IRVINE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-3940
Practice Address - Country:US
Practice Address - Phone:949-824-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics