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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

DR. GARY DEBOER WALLACE
NPI 1366374126
Student in an Organized Health Care Education/Training Program in Cheyenne, WY

Active since June 03, 2026
820 E 17TH ST, CHEYENNE, WY 82001(307) 632-2434 Get Directions Write a Review

NPPES record added: June 3, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Gary Deboer Wallace NPPES

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

DR. GARY DEBOER WALLACE (NPI 1366374126) is an individual student in an organized health care education/training program in Cheyenne, Wyoming and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1366374126
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. GARY DEBOER WALLACE
Location Address820 E 17TH STCheyenne, WY 82001-4714
Mailing Address820 E 17th StCheyenne, WY 82001-4714 · (307) 632-2434
Phone(307) 632-2434
Sole ProprietorYes
Enumeration DateJune 3, 2026
NPPES CertifiedJune 3, 2026
✔ NPI 1366374126 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
820 E 17TH ST, Cheyenne, WY 82001
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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.

DR. CHRISTIAN ALEXANDER FLANDERS M.D.
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 632-2434
UNIVERSITY OF WYOMING
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 777-7911
ZACHARY DALE HERMAN
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 632-2434
ERIN ELAINE FORTNER D.O.
Student in an Organized Health Care Education/Training Program
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 632-2434
DR. LINDSEY YELTON
Student in an Organized Health Care Education/Training Program
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 634-2434
KAVITHA SRINIVASAN MD
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 632-2434
KRISTEN LEIGH BREHM MD
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 632-2434
SAMANTHA ERIN TOWNSEND MD
Family Medicine
820 E 17TH ST
CHEYENNE, WY 82001
Laramie County (307) 777-7911

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 Gary Wallace's NPI number?

The NPI number for Gary Wallace is 1366374126. It was assigned to this individual provider in the NPPES registry on June 3, 2026.

Where is Gary Wallace located?

Gary Wallace practices at 820 E 17th St, Cheyenne, WY 82001. The listed phone number is (307) 632-2434.

What is Gary Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Gary Wallace was last updated on June 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.