Individual
DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
738 GOLDEN PHEASANT DR, DRAPER, UT 84020-8454
(801) 403-7980
Mailing address
738 GOLDEN PHEASANT DR, DRAPER, UT 84020-8454
(801) 403-7980
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
15448
MS
207L00000X
Anesthesiology Physician
Primary
272263-1205
UT
207L00000X
Anesthesiology Physician
5101010132
MI
207L00000X
Anesthesiology Physician
O-168
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D4253
—
UT
Enumeration date
09/08/2005
Last updated
10/10/2007
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