# DR. MARK ALLEN WALLACE

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

## Provider details

- **NPI number:** 1952591828
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | DO3910 | ME | — |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | DO3910 | ME | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 5101015234 | MI | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | DO3910 | ME | Yes |

## Other

- **Enumeration date:** 07/27/2007
- **Last updated:** 01/29/2026