IndividualActive
Brent Wallace, MD
NPI 1124136221 · Family Medicine Physician · Roy, UT
Provider details
- NPI number
- 1124136221
- Entity type
- Individual
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 771610101205 (UT)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1915 W 5950 S
Roy, UT 84067-1454
Phone: (801) 387-8100
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 27128
Salt Lake City, UT 84127-0128
Registry dates
- Enumerated
- 2006-08-28
- Last updated
- 2008-07-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.