Dr. John Widtsoe Wallace , MD
Specialist • Medina, OH
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. John Wallace has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. John Wallace, MD was a registered Specialist practicing in Medina, OH. Throughout an active medical career spanning 9 years, Dr. Wallace provided care at the practice location at 1091 SOUTHPORT DR until profile deactivation on 2020-03-12.
Practice Location & Contact Primary Location
1091 Southport Dr
Medina, OH 442563019
Specialty Benchmarks & Practice Insights
Comparative analytics for Specialist in Medina, OH
Practicing in Medina, OH (1444 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 174400000X
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on March 12, 2020
NPI status registered as active in NPPES database
Registered at 1091 SOUTHPORT DR, MEDINA, OH 442563019 (Tel: 3307252205)
Registered at 1091 SOUTHPORT DR, MEDINA, OH 442563019 (Tel: 3307252205)
Recorded as JOHN WALLACE, M.D.
Specialist (License #35.044676 in OH)
First registered as active Individual Practitioner in NPPES Database.
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Mailing Address
1091 Southport Dr
Medina, OH 442563019
Phone: 3307252205
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