Wallace, Sharon K
Wallace, Sharon K is an individual health care provider with primary practice located at 70 Doctors' Park , Cape Girardeau MO 63703. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Neuroradiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is her primary health care specialty. Wallace, Sharon K can be contacted via phone (573) 334-6071.Contact Information
Primary practice address
70 Doctors' Park
Cape Girardeau MO 63703
Phone: (573) 334-6071
Fax: (573) 334-4739
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | D0063205 | Maryland |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 2009008972 | Missouri |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 2009008972 | Missouri |
Profile Details
| NPI number | 1629023239 |
|---|---|
| LBN Legal business name | Wallace, Sharon K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2006 |
| Last updated | Dec 4th, 2013 - about 11 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 | 1629023239 | NPPES |
| Maryland | Other | KDA7 / 645989-01 | BC / BS OF MD |
| Maryland | Other | S187 / 0024 | BC / BS OF MD |
| Maryland | MEDICAID | 408165000 | BC / BS OF MD |
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