Wallace, Darryl
Wallace, Darryl is an individual health care provider with primary practice located at 4321 Washington St Suite 4000, Kansas City MO 64111-5961. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecologic Oncology, which is considered as his primary health care specialty. Wallace, Darryl can be contacted via phone (816) 932-4549.Contact Information
Primary practice address
4321 Washington St Suite 4000
Kansas City MO 64111-5961
Phone: (816) 932-4549
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gynecologic Oncology | 207VX0201X | 415529 | Kansas |
| Allopathic & Osteopathic Physicians / Gynecologic Oncology | 207VX0201X | R5048 | Missouri |
Profile Details
| NPI number | 1477592210 |
|---|---|
| LBN Legal business name | Wallace, Darryl |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2006 |
| Last updated | Oct 11th, 2012 - about 12 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 | 1477592210 | NPPES |
| Missouri | MEDICAID | 201094802 | |
| Missouri | Other | 33690 | |
| Missouri | Other | 09381035 | |
| Missouri | Other | 910000367 | |
| Missouri | Other | 4602518 | |
| Missouri | Other | 7400202 |
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