Individual
DR. GREGORY L. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
204 MCCOLLUM DR, SUITE 101, LARAMIE, WY 82070-5151
(307) 745-6065
(307) 745-4936
Mailing address
204 MCCOLLUM DR, SUITE 101, LARAMIE, WY 82070-5151
(307) 745-6065
(307) 745-4936
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
9296A
WY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2009
Last updated
07/01/2013
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