MARK E WALLACE (NPI# 1083603088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083603088 |
| Entity Type | Individual |
| Full Name | MARK E WALLACE |
| Credential | MD |
| Practice Address |
1600 23rd Ave Greeley CO 80634-6070 |
| Practice Telephone | 9703562424 |
| Practice Fax Number | 9703462774 |
| Mailing Telephone | 9703562424 |
| Mailing Fax Number | 9703462774 |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2010-12-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | G056273 | CA | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | DR32010 | CO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 01320100 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538533005 | Mark Thomas Wallace | Speech-Language Pathologist | 2337 N 2nd St, Harrisburg, PA 17110-1009 | 2015-11-21 |
| 1942241096 | Mark Alan Wallace | Chiropractor | 2140 W Poplar Ave, Suite 107, Collierville, TN 38017-0624 | 2006-06-09 |
| 1669467213 | Mark Spangler Wallace | Dentist | 168 N 1950 W Ste 202, Salt Lake City, UT 84116-3007 | 2005-09-20 |
| 1932104205 | Mark Randall Wallace | Internal Medicine | 13400 E Shea Blvd, Scottsdale, AZ 85259 | 2005-06-14 |
| 1760753008 | Mark Edward Wallace | Psychiatry & Neurology | 77 7th Ave, #19d, New York, NY 10011-6645 | 2012-01-18 |
| 1205110434 | Mark James Wallace | Pharmacist | 301 S Sante Fe Ave, Edmond, OK 73003 | 2011-10-06 |
| 1932367539 | Mark Richard Wallace | Chiropractor | 9337 W 75th St, Overland Park, KS 66204 | 2008-05-30 |
| 1316119548 | Mark Steven Wallace | Hearing Instrument Specialist | 202 Grand Ave, Spencer, IA 51301 | 2008-03-27 |
| 1952591828 | Mark Allen Wallace | Otolaryngology | 333 Magazine St, Suite 101, Sault Sainte Marie, MI 49783-1867 | 2007-07-27 |
| 1104047190 | Mark C Wallace | Dentist | 50 County Road B E, Saint Paul, MN 55117-1927 | 2007-05-01 |
| Street Address |
1600 23RD AVE |
| City | GREELEY |
| State | CO |
| Zip Code | 80634-6070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811986169 | Herbert Daniel Fahrenholtz | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2005-10-19 |
| 1780208991 | Obstetrix Medical Group of Colorado, P.C. | Pediatrics | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-06-03 |
| 1316561871 | Hendrik Ryan Lumakang Tan | Student in an Organized Health Care Education/Training Program | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-06-01 |
| 1679197131 | Hans Carl Humrick | Student in an Organized Health Care Education/Training Program | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-06-01 |
| 1194348862 | Shannon Mary Shaw | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-28 |
| 1053934711 | Drake Evan Sisneros | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-28 |
| 1215551957 | Darin Trey Sisneros | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-28 |
| 1801419627 | Tyler Clay Ulmer | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-27 |
| 1619590494 | Garrett Sanford Mayo | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-27 |
| 1508489329 | Karlie Alyce Urbach | Family Medicine | 1600 23rd Ave, Greeley, CO 80634-6070 | 2020-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707843 | Witting Medical, LLC | Pathology | 17 Dos Rios, Greeley, CO 80634 | 2020-07-15 |
| 1730706102 | Heart Centered Counseling | Counselor | 1770 W 25th Street #206, Greeley, CO 80634 | 2020-07-01 |
| 1396374237 | Kidstuff Child and Family Counseling, P.C. | Counselor | 1770 25th Ave., Ste. 102, Greeley, CO 80634 | 2020-04-03 |
| 1164055745 | Stephanie Alexis Balunda | Speech-Language Pathologist | Uchealth Physical Therapy and Rehabilitation Clinic, 6767 West 29th St., Greeley, CO 80634 | 2020-02-21 |
| 1407413727 | Stephen P Street Pllc | Counselor | 4657 W. 20th Street, Unit B, Greeley, CO 80634 | 2019-05-22 |
| 1043797749 | Burt Stewart Dmd Pllc | Clinic/Center | 6937 West 10th Street, Greeley, CO 80634 | 2018-07-25 |
| 1164913885 | Innovations Pediatric Therapy, LLC | Occupational Therapist | 3403 W 7th St Apt A, Greeley, CO 80634 | 2018-05-29 |
| 1003305319 | Austin Michael Lake | Physical Therapist | 4681 W 20th St Unit 202b, Greeley, CO 80634 | 2018-05-02 |
| 1225542004 | Kevin Lichner | Specialist/Technologist | 522 28th Ave, Greeley, CO 80634 | 2017-11-30 |
| 1538683909 | Stacie Jackson | Physician Assistant | 6500 West 29th St Ste 106, Greeley, CO 80634 | 2017-07-27 |
| Find all providers in zip 80634 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073111381 | Paladina Health, LLC | Family Medicine | 3400 W 16th St Ste Y, Greeley, CO 80634-6862 | 2020-10-09 |
| 1598281875 | Front Range Clinic Inc. | Family Medicine | 3400 W 16th St Unit 1-dd, Greeley, CO 80634-6862 | 2017-08-17 |
| 1164710182 | Jose Luis Lopez Rivera | Family Medicine | 1801 16th St # 80631, Greeley, CO 80631-5154 | 2011-07-11 |
| 1396040259 | Howard County Medical Center | Family Medicine | 109 W Oconnor Ave, Greeley, NE 68842 | 2011-01-24 |
| 1598940819 | Marianne Veronica Lyons | Family Medicine | Unc Student Health Cassidy Hall, 1901 10th Ave, Greeley, CO 80639-0001 | 2008-01-05 |
| 1699860296 | Mary Christine Obrien | Family Medicine | Greeley Cboc, 2020 16th St,suite1, Greeley, CO 80634 | 2006-10-03 |
| 1326050550 | Gregory Donald Denzel | Family Medicine | 2928 W 10th St, Greeley, CO 80634-5426 | 2006-08-13 |
| 1497714935 | Marc Ringel | Family Medicine | 2726 W 11th Street Rd, Greeley, CO 80634-5408 | 2006-03-22 |
| 1427023225 | Donald Craig Wilson | Family Medicine | 2520 W 16 St, Greeley, CO 80634 | 2006-02-23 |
| 1376518282 | Lori Ann Ripley | Family Medicine | 2520 W 16th St, Greeley, CO 80634-4941 | 2006-02-22 |
| Find all providers in GREELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.