| R. Duncan Wallace, M.d., P.c. | |
|
2972 S Devonshire Cir Salt Lake City UT 84108-2526 | |
| (801) 355-8323 | |
| Not Available |
| Full Name | R. Duncan Wallace, M.d., P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2972 S Devonshire Cir, Salt Lake City, Utah |
| Authorized Official Name and Position | Kathy Snow (OFFICE MANAGER) |
| Authorized Official Contact | 8014867940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R. Duncan Wallace, M.d., P.c. Po Box 581065 Salt Lake City UT 84158-1065 Ph: (801) 355-8323 | R. Duncan Wallace, M.d., P.c. 2972 S Devonshire Cir Salt Lake City UT 84108-2526 Ph: (801) 355-8323 |
| NPI Number | 1700120334 |
|---|---|
| Provider Enumeration Date | 11/20/2012 |
| Last Update Date | 04/09/2013 |
| Medicare PECOS PAC ID | 8527204932 |
|---|---|
| Medicare Enrollment ID | O20130409000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700120334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 148121-1205 (Utah) | Primary |
| Provider Name | Robert D Wallace |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134133200 PECOS PAC ID: 3870516107 Enrollment ID: I20060112000312 |
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