Provider Demographics
NPI:1851491070
Name:SALTER, WALLACE J (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:J
Last Name:SALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2221 ELM ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5108
Mailing Address - Country:US
Mailing Address - Phone:307-324-2221
Mailing Address - Fax:
Practice Address - Street 1:7325 S PIERCE ST STE 102
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4553
Practice Address - Country:US
Practice Address - Phone:039-729-1383
Practice Address - Fax:303-972-1496
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WYTL5910207Q00000X
CO35071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807209Medicare PIN