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1063732758
IAN WALLACE
LONGMONT, CO
NPI
1063732758
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: CO DR.0052047)
Enumeration Date
2010-06-04
Last Update Date
2023-02-27
Business Address
IAN WALLACE MD
220 E ROGERS RD
LONGMONT, CO 80501-6027
Phone number: 303-697-2583
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Mailing Address
IAN WALLACE MD
203 S ROLLIE AVE
FORT LUPTON, CO 80621-1508
Phone number: 303-892-6401
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