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Individual

DAVID WALLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11700 W 2ND PL, #4-450, LAKEWOOD, CO 80228-1704
(303) 825-1234
(720) 321-8121
Mailing address
11700 W 2ND PL, #4-450, LAKEWOOD, CO 80228-1704
(303) 825-1234
(720) 321-8121

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
17055
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01170554
CO
Enumeration date
05/08/2006
Last updated
03/05/2013
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