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

Jonathan Wesley Wallace, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1487342119

Jonathan Wesley Wallace, MD is a Family Practice in Vancouver, Washington. Graduated from Oregon Health Sciences University School of Medicine in 2023, 3 years ago. Licensed in Washington.

Years since qualifying
3
Trained at
Oregon Health Sciences University School of Medicine
Licensed in
WA
In the registry since
2023
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

100 E 33rd St Ste 100
Vancouver, WA 98663-2776
Phone: (360) 514-7556
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ML61440736 (WA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1487342119
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 1, 2023
Last updated in NPPESMay 5, 2023
Certification dateMay 5, 2023
Mailing address100 E 33rd St Ste 100, Vancouver, WA 98663-2776

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated

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