Mark E Wallace, MD

NPI #1083603088 in Greeley, Colorado

Provider Information

NPI Number: 1083603088
Entity Type: Individual
Name: Mark E Wallace, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: MD
Enumeration Date: Oct 21, 2005
Last Updated: Dec 20, 2010

Practice Location

Address: 1600 23RD AVE
City: Greeley
State: Colorado
ZIP Code: 80634-6070
Phone: (970) 356-2424

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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