Basic Information
| Provider Information | |||||||||
| NPI: | 1710973250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUMSEY | ||||||||
| FirstName: | WALLACE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N EL DORADO PL | ||||||||
| Address2: | SUITE 670 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857154637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207518280 | ||||||||
| FaxNumber: | 5207518281 | ||||||||
| Practice Location | |||||||||
| Address1: | 53 E TALLAHASSEE DR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856412310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207625308 | ||||||||
| FaxNumber: | 5207628431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 11/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3134 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BR2694087 | 01 | AS | DEA | OTHER | 419574 | 05 | AZ | MEDICAID |