Wayne O Wallace Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0413701 Issued in KS

Practice address

810 Raven Hill Drive
Atchison, KS 66002-1401

Phone

(913) 367-6689

Fax

(913) 360-5837

NPI assigned

Jun 28, 2005

Last updated

Jan 28, 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 1

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

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264636800000",
    "number": "1639175292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 RAVEN HILL DRIVE",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660021243",
            "telephone_number": "913-367-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 RAVEN HILL DRIVE",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660021401",
            "telephone_number": "913-367-6689",
            "fax_number": "913-360-5837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WAYNE",
        "middle_name": "O",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2010-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0413701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098780I",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Vandyne, DDS
• Molly Ann Vanpetten, M.D.
• Cassandra D. Vilander, APRN
• Vintage Park at Atchison LLC
• Ronald W Wagner, PT, DPT
• Walmart Inc. (Walmart Pharmacy 10-1054)
• Roderick Warren, MD
• Jason R Wells, PSYD
• Elizabethann West, CD(DONA)
• Stephen William Wheatley, D.C.

• Family Medicine Physician in Atchison, KS
• Providers in Atchison, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.