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General NPI Number Information
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NPI Number | 1740279389
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Entity Type | Individual
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Provider Name | WALLACE CHESTER WALKER MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 225 BIG TIMBER LOOP RD
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City | BIG TIMBER
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State | MT
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Zip | 59011-7646
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Country | US
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Telephone | 406-932-7100
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Fax | 406-932-7102
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Provider Business Mailing Address
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Address Line | PO BOX 1267
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City | BIG TIMBER
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State | MT
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Zip | 59011-1267
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Country | US
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Telephone | 406-932-5419
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Fax | 406-932-5515
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6045
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License Number State | MT
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