Individual Healthcare Provider
Graham Wilson Wallace, MD
Provider's NPPES record last updated: September 4, 2024
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1063499267
- Primary Specialty
- Radiology — Diagnostic Radiology
- Practice Location
- Denver, Colorado
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 18, 2026, 1:05 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Radiology
Diagnostic Radiology
Allopathic & Osteopathic Physicians
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Taxonomy code 2085R0202X Family Medicine
Allopathic & Osteopathic Physicians
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.
Taxonomy code 207Q00000X
Provider-Reported License Information
- Radiology (Colorado)
- DR.0068264
- Family Medicine (Indiana)
- 01051128A
- Radiology (Indiana)
- 01051128A
- Radiology (California)
- C142217
Practice Locations
Practice Location
777 Bannock St
Denver, Colorado 80204-4597
Phone: (303) 643-6494
Additional Practice Location
David Grant Medical Center
101 Bodin Circle
Travis Afb, California 94535-1809
Phone: (707) 423-3040
Additional Practice Location
Kaiser Permanente
4601 Dale Rd.
Modesto, California 95356
Phone: (209) 735-3290
Fax: (877) 516-6086
Additional Practice Location
University of California San Francisco
505 Parnassus Ave.
San Francisco, California 94143
Phone: (415) 885-7268
Fax: (415) 885-7445
Record Information
- Enumeration Date
- December 29, 2005
- Provider's NPPES Record Last Updated
- September 4, 2024
- Certification Date
- September 4, 2024
- NPISignal NPPES Dataset
- August 2026
See Something Wrong?
Incorrect provider information
Everything on this page comes directly from the NPPES data CMS publishes. NPISignal cannot edit a provider's record — only the provider or organization can, directly through NPPES.
Update a record through NPPESSomething wrong with this page?
If NPISignal is displaying this data incorrectly — a formatting error, a broken link, a mismatch with the source file — let us know.
Report a display issue