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:
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Health care specialties

SpecialtyCodeLicense #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 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 1730128372 NPPES
Arizona MEDICAID 323923

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