Wallace, Kevin L
Wallace, Kevin L is an individual health care provider with primary practice located at 925 E Mcdowell Rd , Phoenix AZ 85006-2502. He recently has only one registered license in Allopathic & Osteopathic Physicians / Medical Toxicology, which is considered as his primary health care specialty. Wallace, Kevin L can be contacted via phone (602) 239-2371.Contact Information
Primary practice address
925 E Mcdowell Rd
Phoenix AZ 85006-2502
Phone: (602) 239-2371
Fax: (602) 239-4138
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Medical Toxicology | 2083T0002X | 23348 | Arizona |
Profile Details
NPI number | 1730128372 |
---|---|
LBN Legal business name | Wallace, Kevin L |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 6th, 2006 |
Last updated | Jul 8th, 2007 - about 17 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 | 1730128372 | NPPES |
Arizona | MEDICAID | 323923 |
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