Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Graham Wilson Wallace, MD

Individual provider Family Medicine Physician · NPI 1063499267

Dr. Graham Wilson Wallace, MD is a Diagnostic Radiology in Denver, Colorado. Qualified in 1998, 28 years ago. Practices with New York University, a 5,884-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in California, Colorado and Indiana.

Years since qualifying
28
Licensed in
CA, CO, IN
In the registry since
2005
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

777 Bannock St
Denver, CO 80204-4597
Phone: (303) 643-6494
Fax: (303) 602-4168
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • Kaiser Permanente, Modesto, CA 95356 — (209) 735-3290
  • University Of California San Francisco, San Francisco, CA 94143 — (415) 885-7268
  • David Grant Medical Center, Travis Afb, CA 94535-1809 — (707) 423-3040

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence DR.0068264 (CO)
Family Medicine Physician Taxonomy 207Q00000X · Licence 01051128A (IN)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 01051128A (IN)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence C142217 (CA)

Record details

NPI number1063499267
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedDecember 29, 2005
Last updated in NPPESSeptember 4, 2024
Certification dateSeptember 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Group practice New York University — 5884 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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