MEDICARE: DR. GREGORY L. WALLACE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	9296A	WY

General Provider Information

NPI Number	:	1770712309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY L. WALLACE MD

Provider Business Mailing Address
First Line	:	204 MCCOLLUM DR
Second Line	:	SUITE 101
City	:	LARAMIE
State	:	WY
Zip	:	82070-5151
Country	:	US
Telephone Number	:	307-745-6065
Fax Number	:	307-745-4936

Provider Business Practice Location Address
First Line	:	204 MCCOLLUM DR
Second Line	:	SUITE 101
City	:	LARAMIE
State	:	WY
Zip	:	82070-5151
Country	:	US
Telephone Number	:	307-745-6065
Fax Number	:	307-745-4936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/01/2013

Similar Medicare Providers

1053098749 — SALLY RAFERT FNP-C
Practice Location Address:

204 MCCOLLUM ST STE 104
LARAMIE, WY
82070-5151

Practice Phone: 307-745-0085
Practice Fax:

1912098211 — HIGH PLAINS GENERAL SURGERY INC
Practice Location Address:

204 MCCOLLUM DR , SUITE 101
LARAMIE, WY
82070-5151

Practice Phone: 307-745-9099
Practice Fax: 307-745-4936

1972658250 — WYOMED LABORATORY, INC
Practice Location Address:

204 MCCOLLUM ST STE 105
LARAMIE, WY
82070-5151

Practice Phone: 307-721-5111
Practice Fax: 307-745-5732

1285777607 — FAMILY CARE CLINIC, LLC
Practice Location Address:

204 MCCOLLUM ST STE 104
LARAMIE, WY
82070-5151

Practice Phone: 307-745-0085
Practice Fax: 307-745-0084

1407000342 — SUMMIT HOME HEALTH CARE
Practice Location Address:

204 MCCOLLUM DR STE 106
LARAMIE, WY
82070-5151

Practice Phone: 307-721-2827
Practice Fax: 307-742-3611

1033555230 — DR. SAMUEL BLAKE ECKER D.O.
Practice Location Address:

204 MCCOLLUM ST STE 106E
LARAMIE, WY
82070-5151

Practice Phone: 970-682-3377
Practice Fax: 970-682-3340

Directions to “ DR. GREGORY L. WALLACE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.