Stephen A Wallace, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

13856 Issued in AZ

Practice address

2741 S 8TH Ave
Suite C
Yuma, AZ 85364-7154

Phone

(928) 726-0985

NPI assigned

Aug 18, 2005

Reactivated

Mar 28, 2006

Last updated

Nov 17, 2009By 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 1

Addresses

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

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Jessica Duggan DPM PC

  • Foot & Ankle Surgery Podiatrist
  • Yuma, AZ
  • NPI 1134560097
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1336131044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SUITE C",
            "address_2": "2741 S 8TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647154",
            "telephone_number": "928-726-0985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2741 S 8TH AVE",
            "address_2": "SUITE C",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647154",
            "telephone_number": "928-726-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHEN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2009-11-17",
        "deactivation_date": "2006-03-23",
        "reactivation_date": "2006-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AZ",
            "license": "13856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindy Walker, WHNP
• Robert Vananthony Walker
• Tiffany Walker, PMHNP-C
• Juliann Maria Wallace, RN
• Melissa Marie Wallace
• Tor Erik William Wallstrom, M.D.
• Walmart Inc. (Walmart Pharmacy 10-7320)
• Walmart Inc. (Walmart Pharmacy 10-1474)
• Walmart Inc. (Walmart Pharmacy 10-5342)
• Walmart Inc. (Walmart Pharmacy 10-4325)

• Pain Medicine (Anesthesiology) Physician in Yuma, AZ
• Providers in Yuma, AZ by specialty
• Pain Medicine (Anesthesiology) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.