Provider Demographics
NPI:1063413417
Name:ALWARD, WALLACE LM (MD)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:LM
Last Name:ALWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3938
Mailing Address - Fax:319-353-7699
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3938
Practice Address - Fax:319-353-7699
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA25945207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0250522Medicaid
IA25052OtherWELLMARK BCBS
IA25052OtherWELLMARK BCBS
IA0250522Medicaid