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Individual

DR. RICHARD M. WALLACE

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
925 HIGHLAND BLVD.,, SUITE 1180, BOZEMAN, MT 59715
(406) 587-8631
(406) 587-1343
Mailing address
925 HIGHLAND BLVD.,, SUITE 1180, BOZEMAN, MT 59715
(406) 587-8631
(406) 587-1343

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
6907
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0089427
MT
05
0144690
MT
Enumeration date
04/04/2006
Last updated
07/09/2007
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