Individual
DR. MARK RANDALL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259
(480) 301-8000
Mailing address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259-5452
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19816
AZ
Other
Enumeration date
06/14/2005
Last updated
09/03/2020
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