Provider Demographics
NPI:1992344964
Name:TWYMAN, WALLACE ELTON III
Entity type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:ELTON
Last Name:TWYMAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 GLEAMING DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-1960
Mailing Address - Country:US
Mailing Address - Phone:804-347-7791
Mailing Address - Fax:
Practice Address - Street 1:3700 GLEAMING DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-1960
Practice Address - Country:US
Practice Address - Phone:804-347-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program