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Individual
STEPHEN BLAKE WALLACE
Active
Individual
STEPHEN BLAKE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
DR.0063577
CO
Other
Enumeration date
04/13/2015
Last updated
07/29/2020
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