Individual
AMANDA FRASER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
755 HERITAGE RD, GOLDEN, CO 80401-3600
(303) 277-0700
Mailing address
1818 E 7TH AVE, DENVER, CO 80218-3645
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
DR0052096
CO
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
0052096
CO
Other
Enumeration date
06/22/2009
Last updated
01/07/2019
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