Wallace, Stephen

Wallace, Stephen is an sole proprietor health care provider with primary practice located at 1200 College Dr , Rock Springs WY 82901-5868. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Wallace, Stephen can be contacted via phone (307) 362-3711.

Contact Information

Primary practice address
1200 College Dr Rock Springs WY 82901-5868
Phone: (307) 362-3711
Fax: (307) 352-8178
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X M8716 Idaho
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 6690A Wyoming

Profile Details

NPI number 1851379119
LBN Legal business name Wallace, Stephen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 6th, 2006
Last updated May 6th, 2008 - about 18 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 1851379119 NPPES
Wyoming Other 605960009 FBL
Wyoming Other 314686 FBL
Wyoming MEDICAID 806470900 FBL
Wyoming Other 58024 FBL

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