Individual
DR. GENEVIEVE REBECCA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1056 S 88TH ST, LOUISVILLE, CO 80027-9460
(303) 442-6647
(303) 442-2696
Mailing address
1056 S 88TH ST, LOUISVILLE, CO 80027-9460
(303) 442-6647
(303) 442-2696
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
DR.0057122
CO
207ZD0900X
Dermatopathology (Pathology) Physician
57122
CO
Other
Enumeration date
10/29/2007
Last updated
06/02/2022
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