NPI 1518001312

B J Wallace

Practitioner General Practice Physician Englewood, CO

Practice location

Address: 2955 S Broadway, Englewood, CO 80113-1526
Phone: (303) 788-1124

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 11470 (CO)

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Registry record

NPI: 1518001312
Entity type: Individual
Sex (as registered): Female
NPI issued: 16 Feb 2007
Record last updated: 5 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.