Wallace Blake McKinney Medical Group of California

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

WALLACE BLAKE MCKINNEY MEDICAL GROUP OF CALIFORNIA

Practice address

9245 Laguna Springs Dr Ste 200
Elk Grove, CA 95758-7991

Phone

(916) 215-4554

NPI assigned

Sep 29, 2018

Organization subpart

No

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

Authorized official

Name

Dr. John Dutton, MD

Title

Medical Director

Phone

(916) 215-4554

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1538179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1861977415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3513 BRIGHTON BLVD STE 230",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802163606",
            "telephone_number": "916-215-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9245 LAGUNA SPRINGS DR STE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587991",
            "telephone_number": "916-215-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE BLAKE MCKINNEY MEDICAL GROUP OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-29",
        "last_updated": "2021-03-15",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "DUTTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "916-215-4554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Marie Walker
• Dawn Walker, MHAI
• Eric Walker
• Megan Walker
• Monterya Walker
• Wallace J Bellamy DMD
• Carol L Wallace, MA, LMFT
• Patricia A Wallrich, PA-C
• Walmart Inc.
• Walmart Inc.

• Emergency Medicine Physician in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.