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Individual
DR. MARK ALLEN WALLACE
Active
Individual
DR. MARK ALLEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
DO3910
ME
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
DO3910
ME
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
5101015234
MI
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
DO3910
ME
Other
Enumeration date
07/27/2007
Last updated
01/29/2026
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