Individual
MARSHALL W. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N MARIO CAPECCHI DR RM 4S100, SALT LAKE CITY, UT 84112-0002
(801) 581-2121
Mailing address
30 N MARIO CAPECCHI DR RM 4S100, SALT LAKE CITY, UT 84112-0002
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
14168058-1205
UT
Other
Enumeration date
03/22/2023
Last updated
10/01/2024
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