Prophet, Wallace Dale

Prophet, Wallace Dale is an individual health care provider with primary practice located at 350 Heritage Way Suite 2100, Kalispell MT 59901-3158. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Prophet, Wallace Dale can be contacted via phone (406) 257-8992.

Contact Information

Primary practice address
350 Heritage Way Suite 2100 Kalispell MT 59901-3158
Phone: (406) 257-8992
Fax: (406) 755-4161
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 9734 Alabama
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 49643 Montana

Profile Details

NPI number 1942294426
LBN Legal business name Prophet, Wallace Dale
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2005
Last updated Aug 22nd, 2017 - about 7 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 1942294426 NPPES
Alabama MEDICAID 000012909
Alabama MEDICAID 00284468A
Alabama MEDICAID 068414700

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