NPI 1265075865

Wallace Tranum

Practitioner Driver Deltona, FL

Practice location

Address: 415 Golden Arm Rd, Deltona, FL 32738-8653
Phone: (407) 460-7242

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence T655898694600 (FL)

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Registry record

NPI: 1265075865
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Oct 2019
Record last updated: 26 Oct 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.