Individual
DARRYL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4321 WASHINGTON ST, SUITE 4000, KANSAS CITY, MO 64111-5961
(816) 932-4549
Mailing address
PO BOX 504407, SAINT LOUIS, MO 63150-4407
(816) 932-7947
(816) 932-7957
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
415529
KS
207VX0201X
Gynecologic Oncology Physician
Primary
R5048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09381035
BCBS OF KC
—
05
—
201094802
—
MO
01
—
33690
HEALTHCARE USA
—
01
—
4602518
AETNA
—
01
—
7400202
UHC
—
01
—
910000367
RAILROAD MEDICARE
—
Enumeration date
06/06/2006
Last updated
10/11/2012
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