Provider Demographics
NPI:1710973250
Name:RUMSEY, WALLACE E JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:E
Last Name:RUMSEY
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1200 N EL DORADO PL
Mailing Address - Street 2:SUITE 670
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4637
Mailing Address - Country:US
Mailing Address - Phone:520-751-8280
Mailing Address - Fax:520-751-8281
Practice Address - Street 1:53 E TALLAHASSEE DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:AZ
Practice Address - Zip Code:85641-2310
Practice Address - Country:US
Practice Address - Phone:520-762-5308
Practice Address - Fax:520-762-8431
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AZ3134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ419574Medicaid
AZ419574Medicaid
AZ419574Medicaid