Individual
DR. GRAHAM WILSON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4597
(303) 643-6494
(303) 602-4168
Mailing address
777 BANNOCK ST, DENVER, CO 80204-4597
(303) 643-6494
(303) 602-4168
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01051128A
IN
2085R0202X
Diagnostic Radiology Physician
01051128A
IN
2085R0202X
Diagnostic Radiology Physician
C142217
CA
2085R0202X
Diagnostic Radiology Physician
Primary
DR.0068264
CO
Other
Enumeration date
12/29/2005
Last updated
09/04/2024
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