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

Mark E Wallace, MD

Individual provider Family Medicine Physician · NPI 1083603088

Mark E Wallace, MD is a Family Medicine Physician in Greeley, Colorado. Licensed in California and Colorado. Registered with an NPI since 2005.

Licensed in
CA, CO
In the registry since
2005
Specialties on file
2
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

1600 23rd Ave
Greeley, CO 80634-6070
Phone: (970) 356-2424
Fax: (970) 346-2774
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence DR32010 (CO)
Family Medicine Physician Taxonomy 207Q00000X · Licence G056273 (CA)

Record details

NPI number1083603088
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 21, 2005
Last updated in NPPESDecember 20, 2010
Mailing address1600 23rd Ave, Greeley, CO 80634-6070

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