Individual
BETHANY ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
8890 N UNION BLVD STE 170, COLORADO SPRINGS, CO 80920-2701
(719) 365-6421
(719) 365-6408
Mailing address
558 E CASTLE PINES PKWY PMB 151, CASTLE ROCK, CO 80108-4608
(719) 365-6421
(710) 365-6408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27638
CO
Other
Enumeration date
09/27/2006
Last updated
05/14/2023
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