ERIC WALLACE (NPI# 1578502191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1578502191 |
Entity Type | Individual |
Full Name | ERIC WALLACE |
Credential | MD |
Practice Address |
168 N Brent St Suite 402 Ventura CA 93003-2817 |
Mailing Address |
4100 Guardian St Ste 205 Simi Valley CA 93063-6721 |
Practice Telephone | 8882340004 |
Practice Fax Number | 8056413965 |
Mailing Telephone | 8555044544 |
Mailing Fax Number | 8555772018 |
Enumeration Date | 2006-06-06 |
Last Update Date | 2017-11-14 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
A85195 | CA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | BLUESHIELD OF CA | 00A851950 | 01 |
CA | 00A851950 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417183476 | Eric T Wallace | Physical Therapist | W5361 County Road Kk Ste E, Appleton, WI 54915-7271 | 2009-06-04 |
1922218809 | Eric Wallace | Radiologic Technologist | 4004 Landside Dr, Louisville, KY 40220-3020 | 2007-05-22 |
1871706960 | Eric Wallace | Emergency Medicine | Paula Bldg 230, 728 Richard Arrington Blvd, Birmingham, AL 35294-0001 | 2007-05-07 |
1174665277 | Eric H Wallace | Dentist | 28 Se 6th St, Boca Raton, FL 33432-6016 | 2007-02-13 |
1780614529 | Eric L. Wallace | Surgery | 1450 Matthews Township Parkway, Suite 300, Matthews, NC 28105 | 2006-07-04 |
1912409160 | Eric Wallace | Psychologist | 22001 Fairmount Blvd, Shaker Heights, OH 44118-4819 | 2018-03-05 |
1528333838 | Eric Joseph Wallace Jr. | Radiology | 1542 Tulane Ave, Room 353, New Orleans, LA 70112-2865 | 2012-03-20 |
1568658243 | Eric L Wallace | Internal Medicine | 700 W Ironwood Dr, 320, Coeur D Alene, ID 83814-2656 | 2007-09-17 |
1891838991 | Eric Michael Wallace | Dentist | 1515 State St, Suite 9, Santa Barbara, CA 93101-2536 | 2007-02-15 |
1154434488 | Eric Wallace | Family Medicine | 143 Longwater Dr, Norwell, MA 02061-1683 | 2006-08-17 |
Street Address |
168 N BRENT ST SUITE 402 |
City | VENTURA |
State | CA |
Zip Code | 93003-2817 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013919133 | Jeffrey C Brackett | Internal Medicine | 168 N Brent St, Ste 503, Ventura, CA 93003-2840 | 2005-06-01 |
1932731866 | Sally F Mcnally | Advanced Practice Midwife | 168 N Brent St, Ventura, CA 93003-2817 | 2020-02-08 |
1710367693 | Stephan Sweet, M.d. Inc. | Orthopaedic Surgery | 168 N Brent St, Ste 505, Ventura, CA 93003-2817 | 2015-06-04 |
1518363001 | Robert T Mazurek M D A Professional | Specialist | 168 N Brent St, Suite 501, Ventura, CA 93003-2817 | 2014-11-10 |
1013312594 | Antulio B Aroche Jr Do A Professional Corporation | Orthopaedic Surgery | 168 N Brent St, Suite 505, Ventura, CA 93003-2817 | 2014-10-27 |
1861738718 | Diane Jeanne Milstead | Advanced Practice Midwife | 168 N Brent St, 407, Ventura, CA 93003-2817 | 2012-12-21 |
1699011569 | Ventura County Neurosurgery Associates Medical Group | Neurological Surgery | 168 N Brent St, Suite 408, Ventura, CA 93003-2817 | 2012-12-21 |
1083950018 | David L. Westra, Md, A Professional Corporation | Neurological Surgery | 168 N Brent St, Suite 408, Ventura, CA 93003-2817 | 2012-12-19 |
1164768107 | Michael J Dorsi, M.d., A Professional Corporation | Neurological Surgery | 168 N Brent St, Suite 408, Ventura, CA 93003-2817 | 2012-12-19 |
1164766291 | Tracy Ann Lyou | Nurse Practitioner | 168 N Brent St, Suite 502, Ventura, CA 93003-2817 | 2012-11-15 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124645924 | Community Memorial Health System | Pharmacy | 2790 Loma Vista Road, Ventura, CA 93003 | 2020-06-29 |
1730702952 | Sarah Manon Begert | Student in an Organized Health Care Education/Training Program | 300 Hillmont Ave., Bldg 340, Ste 201, Ventura, CA 93003 | 2020-05-21 |
1033763677 | Ashley Danielle Aguilar | Counselor | 5740 Ralston Suite 100, Ventura, CA 93003 | 2019-08-01 |
1730747239 | Azadeh Ellsworth | Nurse Practitioner | 1752 S Victoria Ave Ste 250, Ventura, CA 93003 | 2019-05-31 |
1992275556 | Melissa Marie Cole | Social Worker | 4949 Market St, Ventura, CA 93003 | 2018-11-27 |
1851868400 | Weldon Acupuncture Professional Corporation | Acupuncturist | 3737 Telegraph Road, Suite F, Ventura, CA 93003 | 2018-10-31 |
1952876468 | Isabella Florencia Gallegos | Specialist/Technologist | 1857 Knoll Dr., Ventura, CA 93003 | 2018-10-11 |
1437645421 | Jill Huang Wong | Psychologist | 3585 Maple St Ste 248, Ventura, CA 93003 | 2018-07-02 |
1346735156 | Lisa Ngoc Thi Nguyen | Student in an Organized Health Care Education/Training Program | 147 N. Brent Street, Ventura, CA 93003 | 2018-06-25 |
1457845331 | Khloe Frank | Student in an Organized Health Care Education/Training Program | 300 Hillmont Ave, Bldg 340, Suite 201, Ventura, CA 93003 | 2018-06-14 |
Find all providers in zip 93003 |
Taxonomy Code | 2085R0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Radiology |
Specialization | Diagnostic Radiology |
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710339833 | Stockdale Radiology Physician Services, Inc | Radiology | 875 Weber Cir, # 201, Ventura, CA 93003-8252 | 2016-07-13 |
1538547088 | Quantum Medical Radiology of California, PC | Radiology | 1990 Sunset Dr, Ventura, CA 93001-2355 | 2015-05-15 |
1619313566 | Roger Goldman | Radiology | 6250 Telegraph Rd Apt 1310, Ventura, CA 93003 | 2013-05-20 |
1306098751 | Bahn Consulting Medical Group, Inc. | Radiology | 168 N Brent St, Suite 402, Ventura, CA 93003 | 2008-10-16 |
1134283344 | Bruce Matthews | Radiology | 3291 Loma Vista Rd, Ventura, CA 93003-3099 | 2006-12-21 |
1104980317 | John Mcmahan | Radiology | 3291 Loma Vista Rd, Ventura, CA 93003-3099 | 2006-12-21 |
1336202365 | Matthew Carr | Radiology | 3291 Loma Vista Rd, Ventura, CA 93003-3099 | 2006-12-19 |
1558420398 | Reed M. Horwitz | Radiology | 3291 Loma Vista Rd, Department of Radiology Vcmc, Ventura, CA 93003-3099 | 2006-12-07 |
1104916253 | Kristina L Jong | Radiology | 168 N Brent St, Suite 401, Ventura, CA 93003-2817 | 2006-10-12 |
1316986938 | Kyu Choi | Radiology | 147 N Brent St, Radiology Department, Ventura, CA 93003-2809 | 2006-06-06 |
Find all providers in VENTURA |
Please comment or provide details below to improve the information on ERIC WALLACE.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.