# AARON J WALLACE, MD,PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841422003
- **Authorized official:** DR. AARON J WALLACE M.D. (OWNER)
- **Authorized official phone:** (870) 424-4710

## Contact information

- **Practice address:** 628 HOSPITAL DR, SUITE E, MOUNTAIN HOME, AR 72653-2953
- **Practice address phone:** (870) 424-4710
- **Practice address fax:** (870) 424-4780
- **Mailing address:** PO BOX 9178, RUSSELLVILLE, AR 72811-9178
- **Mailing address phone:** (479) 968-4273
- **Mailing address fax:** (479) 968-1363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2009
- **Last updated:** 06/24/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 179058002 | — | AR |
| 01 | — | 5G172 | BCBS | AR |