Individual
JEFFREY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12605 E 16TH AVE, AURORA, CO 80045-2545
(720) 848-0000
Mailing address
PO BOX 876, AURORA, CO 80040-0876
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
0027855
CO
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
27855
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37850539
—
CO
Enumeration date
10/13/2006
Last updated
05/08/2025
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