Wallace, Richard M.
Wallace, Richard M. is an individual health care provider with primary practice located at 925 Highland Blvd., Suite 1180, Bozeman MT 59715. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Wallace, Richard M. can be contacted via phone (406) 587-8631.Contact Information
Primary practice address
925 Highland Blvd., Suite 1180
Bozeman MT 59715
Phone: (406) 587-8631
Fax: (406) 587-1343
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 6907 | Montana |
Profile Details
| NPI number | 1881656940 |
|---|---|
| LBN Legal business name | Wallace, Richard M. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 4th, 2006 |
| Last updated | Jul 9th, 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 | 1881656940 | NPPES |
| Montana | MEDICAID | 0144690 | |
| Montana | MEDICAID | 0089427 |
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