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

Mr. John David Wallace, PA-C

Individual provider Physician Assistant · NPI 1487909511

Mr. John David Wallace, PA-C is a Physician Assistant in East Jordan, Michigan. Works from 2 locations. Licensed in Michigan.

Licensed in
MI
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

601 Bridge St
East Jordan, MI 49727-9383
Phone: (231) 536-2206
Fax: (231) 536-7150
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6135 Cressy St, Indian River, MI 49749-5151 — (231) 238-8908

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601006422 (MI)

Record details

NPI number1487909511
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 15, 2012
Last updated in NPPESSeptember 20, 2022
Certification dateSeptember 20, 2022
Mailing address601 Bridge St, East Jordan, MI 49727-9383