GRANT C. WALLACE M.D. – NPI #1043208101
Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

GRANT WALLACE is a radiologist located in OCEANSIDE, CA. NPPES has assigned the NPI number 1043208101 to GRANT WALLACE on October 12, 2005. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 2085R0202X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Diagnostic Radiology

The NPI profile was previously updated about 3 years ago on Sep 25, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GRANT WALLACE below.

NPI Profile for
GRANT C. WALLACE

NPI Number
1043208101
Enumeration Date

(more than 20 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
GRANT C. WALLACE
Credentials
M.D.
Primary location
200 MERCY CIRCLE
OCEANSIDE, CA 92055
Phone: (760) 719-3479 Fax:
Mailing address
Same as primary location
Sole Proprietor
No
Updated
Certification Date
Sep 22, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085R0202X
- Radiology / Diagnostic Radiology (Primary)
CA G80310

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.