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General NPI Number Information
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NPI Number | 1477592210
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Entity Type | Individual
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Provider Name | DARRYL WALLACE MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 4321 WASHINGTON ST SUITE 4000
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City | KANSAS CITY
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State | MO
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Zip | 64111-5961
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Country | US
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Telephone | 816-932-4549
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504407
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City | SAINT LOUIS
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State | MO
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Zip | 63150-4407
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Country | US
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Telephone | 816-932-7947
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Fax | 816-932-7957
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 415529
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | R5048
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License Number State | MO
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