JASON R WALLACE

PAGOSA SPRINGS, CO
NPI1992020937
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: CO  DR.0050788)
Enumeration Date2010-04-01
Last Update Date2020-07-22
Business Address
JASON R WALLACE DO
95 S PAGOSA BLVD
PAGOSA SPRINGS, CO 81147-8329
Phone number: 970-731-3700
Mailing Address
JASON R WALLACE DO
95 S PAGOSA BLVD
PAGOSA SPRINGS, CO 81147-8329
Phone number: 970-731-3700