Wallace, Mark E
Wallace, Mark E is an individual health care provider with primary practice located at 1600 23Rd Ave , Greeley CO 80634-6070. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wallace, Mark E can be contacted via phone (970) 356-2424.Contact Information
Primary practice address
1600 23Rd Ave
Greeley CO 80634-6070
Phone: (970) 356-2424
Fax: (970) 346-2774
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | DR32010 | Colorado |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | G056273 | California |
Profile Details
| NPI number | 1083603088 |
|---|---|
| LBN Legal business name | Wallace, Mark E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 21st, 2005 |
| Last updated | Dec 20th, 2010 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083603088 | NPPES |
| Colorado | MEDICAID | 01320100 |
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