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Individual
DR. KENNETH C WALLIS
Active
Individual
DR. KENNETH C WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
811674181205
UT
2084P0800X
Psychiatry Physician
C-41960
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107005564101
INTRMTN. HEALTH CARE
UT
01
—
261795
DESERET MUTUAL
UT
01
—
942938348WA1
EDUCATORS MUTUAL
UT
Enumeration date
02/09/2006
Last updated
07/09/2021
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