# DR. PATRICK JOSEPH WALLACE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1740219369
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | J7243 | TX | — |
| 2086S0127X | Trauma Surgery Physician | J7243 | TX | Yes |
| 2086X0206X | Surgical Oncology Physician | J7243 | TX | — |

## Other

- **Enumeration date:** 07/03/2006
- **Last updated:** 11/21/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 041937602 | — | TX |
| 01 | — | 8S4802 | BLUE CROSS/BLUE SHIELD | TX |
| 01 | — | P00229401 | MEDICARE RAILROAD | — |