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Individual
DR. PATRICK JOSEPH WALLACE
Active
Individual
DR. PATRICK JOSEPH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
J7243
TX
2086S0127X
Trauma Surgery Physician
Primary
J7243
TX
2086X0206X
Surgical Oncology Physician
J7243
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041937602
—
TX
01
—
8S4802
BLUE CROSS/BLUE SHIELD
TX
01
—
P00229401
MEDICARE RAILROAD
—
Enumeration date
07/03/2006
Last updated
11/21/2023
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