Wallace, Mark R.
Wallace, Mark R. is an individual health care provider with primary practice located at 1400 E Kincaid St , Mount Vernon WA 98274-4127. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Wallace, Mark R. can be contacted via phone (360) 848-4150.Contact Information
Primary practice address
1400 E Kincaid St
Mount Vernon WA 98274-4127
Phone: (360) 848-4150
Fax: (360) 428-6485
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | ME94199 | Florida |
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | MD00020591 | Washington |
Profile Details
| NPI number | 1982683603 |
|---|---|
| LBN Legal business name | Wallace, Mark R. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 11th, 2006 |
| Last updated | Feb 28th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982683603 | NPPES |
| Washington | MEDICAID | 2039554 | |
| Washington | MEDICAID | 275105400 |
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