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Individual
DR. JENNIFER L WALLACE
Active
Individual
DR. JENNIFER L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M D
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H9277
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117537404
—
TX
05
—
117537405
—
TX
05
—
135685902
—
TX
01
—
8DL467
BCBSTX
TX
Enumeration date
09/13/2005
Last updated
04/26/2016
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