DR. BRENT E WALLACE MD
NPI 1124136221
Family Medicine in Roy, UT

Q: What is Brent Wallace's NPI number?

The NPI number for Brent Wallace is 1124136221. It was assigned to this individual provider in the NPPES registry on August 28, 2006.

Q: What is Brent Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Brent Wallace was last updated on July 10, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 28, 2006

1915 W 5950 S, ROY, UT 84067(801) 387-8100 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Brent E Wallace Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BRENT E WALLACE MD (NPI 1124136221) is an individual family medicine provider in Roy, Utah, licensed in Utah (771610101205) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1124136221

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. BRENT E WALLACECredential: MD

Location Address1915 W 5950 SRoy, UT 84067-1454

Mailing AddressPo Box 27128Salt Lake City, UT 84127-0128 · (801) 387-8100

Phone(801) 387-8100

Sole ProprietorNo

Enumeration DateAugust 28, 2006

Last NPPES UpdateJuly 10, 2008

✔ NPI 1124136221 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in UT · 771610101205

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1915 W 5950 S, Roy, UT 84067

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Other Identifiers 5

Medicare UPIND07503

Medicare PIN000005649

Medicaid870348215008UT

Medicare PIN000063588UT

Medicare ID-Type Unspecified000005649UT · Medicare Part B

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KURTIS DON ELLIS M.D.

Family Medicine

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

IHC HEALTH SERVICES INC

Family Medicine

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

JARED DON HIATT DO

Family Medicine

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

RICHARD R RUSSELL PA

Physician Assistant

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

DR. JOHN R WOOD MD

Family Medicine

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

NICHOLAS JAMES BIGGS PA-C

Physician Assistant

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

IHC HEALTH SERVICES INC

Pharmacy (Community/Retail Pharmacy)

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8215

IHC HEALTH SERVICES INC

Clinic/Center (Urgent Care)

1915 W 5950 S
ROY, UT 84067

Weber County (801) 387-8100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brent Wallace's NPI number?

The NPI number for Brent Wallace is 1124136221. It was assigned to this individual provider in the NPPES registry on August 28, 2006.

Where is Brent Wallace located?

Brent Wallace practices at 1915 W 5950 S, Roy, UT 84067. The listed phone number is (801) 387-8100.

What is Brent Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Brent Wallace was last updated on July 10, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.