Wallace, Jennifer

Wallace, Jennifer is an individual health care provider with primary practice located at 2550 E Guadalupe Rd #115, Gilbert AZ 85234-5114. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallace, Jennifer can be contacted via phone (480) 632-1544.

Contact Information

Primary practice address
2550 E Guadalupe Rd #115 Gilbert AZ 85234-5114
Phone: (480) 632-1544
Fax: (480) 632-1533
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 31229 Arizona

Profile Details

NPI number 1912977885
LBN Legal business name Wallace, Jennifer
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912977885 NPPES
Arizona Other 031229 MAYO INSURANCE
Arizona Other 8311240 MAYO INSURANCE
Arizona MEDICAID 831124 MAYO INSURANCE
Arizona Other AZ0734620 MAYO INSURANCE
Arizona Other 1Z9881 MAYO INSURANCE
Arizona Other 00024623 MAYO INSURANCE

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