# DAVID WALLACE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1932193604
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 15448 | MS | — |
| 207L00000X | Anesthesiology Physician | 272263-1205 | UT | Yes |
| 207L00000X | Anesthesiology Physician | 5101010132 | MI | — |
| 207L00000X | Anesthesiology Physician | O-168 | ID | — |

## Other

- **Enumeration date:** 09/08/2005
- **Last updated:** 10/10/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | D4253 | — | UT |