Active NPI
Anne Wallace, MD
- Surgery Physician
- Fort Collins, CO
National Provider Identifier
1972510923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 58303
- Practice address
- 1006 Centre Ave
Fort Collins, CO 80526-1849 - Phone
- (970) 482-9001
- NPI assigned
- Aug 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 58303 | CO | Primary |
Addresses
Primary practice location
1006 Centre Ave
Fort Collins, CO 80526-1849
Mailing address
1006 Centre Ave
Fort Collins, CO 80526-1849
Phone (970) 482-9001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58303 | CO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1972510923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1006 CENTRE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805261849",
"telephone_number": "970-482-9001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 CENTRE AVE",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805261849",
"telephone_number": "970-482-9001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ANNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CO",
"license": "58303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.