Dr. Graham Wilson Wallace
Radiology (Diagnostic Radiology)

Address: Raf Lakenheath 48 Mdg/sgcr, Unit 5210 Box 230, Apo, AE 09461-0230
Phone: 011441638528124

Dr. Graham Wilson Wallace (NPI# 1063499267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1063499267
Entity Type Individual
Full Name Dr. Graham Wilson Wallace
Credential MD
Gender Male
Practice Address Raf Lakenheath 48 Mdg/sgcr
Unit 5210 Box 230
Apo
AE 09461-0230
Practice Telephone 011441638528124
Mailing Address Raf Lakenheath 48 Mdg/sgcr
Unit 5210 Box 230
Apo
AE 09461-0230
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2005-12-29
Last Update Date 2013-07-17

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 207Q00000X Family Medicine Allopathic & Osteopathic Physicians 01051128A IN
Yes 2085R0202X Radiology · Diagnostic Radiology Allopathic & Osteopathic Physicians 01051128A IN

Physician Overview

NPI 1063499267
PAC ID by PECOS 7012200132
Professional Enrollment ID I20160727002064
Full Name Graham Wallace
Organization Legal Name UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER
Phone Number 4154761000
Gender M
Medical School UNIVERSITY OF KANSAS SCHOOL OF MEDICINE
Graduation Year 1998
Primary Specialty DIAGNOSTIC RADIOLOGY
Group Practice PAC ID 4486567229
Number of Group Practice Members 1001
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
050454 UCSF MEDICAL CENTER
050195 WASHINGTON HOSPITAL

Office Location

Street Address RAF LAKENHEATH 48 MDG/SGCR
UNIT 5210 BOX 230
City APO
State AE
Zip Code 09461-0230

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205387081 Joshua Gratz Military Health Care Provider 48mdh/sghc Unit 5115, Apo, AE 09461 2016-10-17
1235414988 Candra R Case Physician Assistant 1 Raf Lakenheath 48 Mdg/sghc, Unit 5115, Apo, AE 09461 2011-10-13
1356539985 Erin Campbell Bott Physical Therapist 48 Mdg Unit5210, Box 230, Apo, AE 09461 2007-10-09
1831249614 Shannon Stewart Enold Social Worker 48 Mdg Sgohf, Unit 5210 Box 230, Apo, AE 09461 2007-01-12
1073674008 Elizabeth Fort Copeland Social Worker Raf Lakenheath 48mdg/sghc, Unit 5115, Apo, AE 09461 2006-12-13
1104995109 Robert Brown Woolley Internal Medicine Raf Lakenheath 48 Mdg/sghc Unit 5115, Apo, AE 09461 2006-11-06
1679592299 Katheryn Willingham Ellis Registered Nurse 48 Mdg Sgobp, Unit 5210 Box 230, Apo, AE 09461 2006-07-18
1306885215 Przemyslaw Konrad Niemczura Dietitian, Registered 48 Medical Group, Unit 5210, Apo, AE 09461 2006-06-06
1760450746 Kathleen King Dobbs Nurse Practitioner 48 Mdg Unit 5210, Box 230, Apo, AE 09461 2006-03-08
1194796573 Renee Spitzer Family Medicine 48th Medical Group, Unit 5210 Box 230, Apo, AE 09461 2006-02-01
Find all providers in zip 09461

Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1851612170 Jiyoon Kim Radiology Meddac-k 121 Csh Unit 15244, Apo, AP 96205 2010-06-22
1720235971 Neel Kumarpal Vaidya Radiology Cmr 402 Box 1234, Landstuhl Regional Medical Center, Apo, AE 09180 2008-08-19
1972546240 Johan K. Ahn Radiology 31 Amds, Unit 6180, Apo, AE 09604-6180 2006-06-14
1922088392 Darryl David Stinson Radiology 3009 Nw Wilson St, Apo, AA 73503-9042 2006-01-20
1164715587 Justin Lamb Radiology 301 Fisher St, Keesler Afb, Apo, AA 39534-2582 2011-05-18
1033347133 Tyler William Rust Radiology 51 Mdg, Unit 2060, Apo, AP 96278-2060 2009-06-26
1346428513 Marc Tubay Radiology Raf Lakenheath 48 Mdg/sghc, Unit 5115, Apo, AE 09461-5115 2008-02-09
1316967078 Lee Michele Kuxhaus Radiology Landstuhl Regional Medical Center, Cmr 402, Apo, AE 09180 2006-07-19
1568433738 Richard Hung Nguyen Radiology Landstuhl Regional Medical Center, Department of Radiology, Cmr 402, Apo, AE 09180 2006-01-27
1780664235 Ricanthony Rene Ashley Radiology Landstuhl Regional Medical Center, Radiology, Apo, AE 09180 2006-01-20
Find all providers in APO

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City APO
Zip Code 09461

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Dataset Information

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.

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