Wallace, Stephen
Wallace, Stephen is an sole proprietor health care provider with primary practice located at 1200 College Dr , Rock Springs WY 82901-5868. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Wallace, Stephen can be contacted via phone (307) 362-3711.Contact Information
Primary practice address
1200 College Dr
Rock Springs WY 82901-5868
Phone: (307) 362-3711
Fax: (307) 352-8178
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | M8716 | Idaho |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 6690A | Wyoming |
Profile Details
| NPI number | 1851379119 |
|---|---|
| LBN Legal business name | Wallace, Stephen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 6th, 2006 |
| Last updated | May 6th, 2008 - about 16 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 | 1851379119 | NPPES |
| Wyoming | Other | 605960009 | FBL |
| Wyoming | Other | 314686 | FBL |
| Wyoming | MEDICAID | 806470900 | FBL |
| Wyoming | Other | 58024 | FBL |
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