Mark D Wallace, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G31736 Issued in CA

Practice address

2020 Court St
Redding, CA 96001-1822

Phone

(530) 243-1236

Fax

(530) 243-8502

NPI assigned

Jul 15, 2006

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)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Medical Doctors Imaging Inc a Medical Group

  • Diagnostic Radiology Physician
  • Redding, CA
  • NPI 1235161480
  NPD (past)
• Regional Radiological Associates, Inc. a Medical Group

  • Diagnostic Radiology Physician
  • Redding, CA
  • NPI 1649202888
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689690091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 492080",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960492080",
            "telephone_number": "530-241-0473",
            "fax_number": "530-241-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 COURT ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011822",
            "telephone_number": "530-243-1236",
            "fax_number": "530-243-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G31736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G317360",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Wall
• Matthew Wall, MASSAGE THERAPIST
• Norman Wall, DO
• Heather Marie Wallace
• Kathleen Wallace, PT, DPT
• Nathan Wallace
• Walmart Inc.
• Walmart, Inc.
• Walter L. Fletscher, M.D., Inc.
• Shelby Lynn Walton

• Diagnostic Radiology Physician in Redding, CA
• Providers in Redding, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.