Mark E Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DR32010 Issued in CO

Practice address

1600 23Rd Ave
Greeley, CO 80634-6070

Phone

(970) 356-2424

Fax

(970) 346-2774

NPI assigned

Oct 21, 2005

Last updated

Dec 20, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mark.wallace.1@27043.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Weld Board of County Commissioners

  dba Weld County Department of Public Health and Environment

  • Public Health or Welfare Agency
  • Greeley, CO
  • NPI 1174515258
  NPD (past)
• Banner - University Hospital Based Physicians LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1538879481
  NPD (past)
• Banner Imaging Services LLC

  • Radiology Clinic/Center
  • Phoenix, AZ
  • NPI 1710733472
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292803200000",
    "number": "1083603088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-356-2424",
            "fax_number": "970-346-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-356-2424",
            "fax_number": "970-346-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2010-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR32010",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G056273",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01320100",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Tierney Walker
• Eric Michael Walker, D.C.
• Hayden Walker, DPT
• Amy Lynn Walkup
• Jennifer Wallace, LCSW
• Josilyn Wallen
• Walmart Inc. (Walmart Pharmacy 10-5051)
• Walmart Inc. (Walmart Pharmacy 10-0980)
• Curtis L Waln, MD
• Elisabeth Kate Walsh

• Family Medicine Physician in Greeley, CO
• Providers in Greeley, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.