MARK D WALLACE M.D. NPI 1689690091

NPI Information

NPI: 1689690091
Provider Name: MARK D WALLACE, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
2020 COURT ST
REDDING, CA
ZIP 96001
Phone: (530) 243-1236
Get Directions

Mark D Wallace, M.D. is a diagnostic radiology radiology in Redding, CA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Mark D Wallace, M.D. NPI is 1689690091. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2020 COURT ST
REDDING, CA
ZIP 96001-822
Phone: (530) 243-1236
Fax: (530) 243-8502

The enumeration date for this NPI number is 7/15/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	G31736	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	00G317360	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA
2	00G317360	MEDICAID	CALIFORNIA
3	A44850	MEDICARE UPIN	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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