Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Grant Charles Wallace, MD

Individual provider Diagnostic Radiology Physician · NPI 1043208101

Dr. Grant Charles Wallace, MD is a Diagnostic Radiology Physician in Oceanside, California. Licensed in California. Registered with an NPI since 2005.

Licensed in
CA
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

200 Mercy Cir
Oceanside, CA 92055
Phone: (760) 719-3479
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence G80310 (CA)

Record details

NPI number1043208101
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 12, 2005
Last updated in NPPESSeptember 25, 2023
Certification dateSeptember 22, 2023

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