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Individual
SCOTT EARL WALLACE
Active
Individual
SCOTT EARL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
W6559
TX
208D00000X
General Practice Physician
34.016172
OH
390200000X
Student in an Organized Health Care Education/Training Program
Primary
34.016172
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2021
Last updated
06/23/2026
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