Wallace, Mark D
Wallace, Mark D is an individual health care provider with primary practice located at 2020 Court St , Redding CA 96001-1822. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wallace, Mark D can be contacted via phone (530) 243-1236.Contact Information
Primary practice address
2020 Court St
Redding CA 96001-1822
Phone: (530) 243-1236
Fax: (530) 243-8502
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | G31736 | California |
Profile Details
| NPI number | 1689690091 |
|---|---|
| LBN Legal business name | Wallace, Mark D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 15th, 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 | 1689690091 | NPPES |
| California | MEDICAID | 00G317360 |
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