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

Mr. Theodore William Wallace, PA-C

Individual provider Physician Assistant · NPI 1609931393

Mr. Theodore William Wallace, PA-C is a Physician Assistant in Tacoma, Washington. Practices as a sole proprietor. Licensed in Washington.

Licensed in
WA
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Partly verified

Some contact details are missing from the federal record.

Madigan Army Medical Ctr 9040A Fitzsimmons Dr
Tacoma, WA 98431-0001
Phone: (253) 968-5161
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Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA100003556 (WA)

Record details

NPI number1609931393
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedDecember 25, 2006
Last updated in NPPESJuly 8, 2007

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