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Organization
JOE L WALLACE, MDPA
Active
Organization
JOE L WALLACE, MDPA
Active
Other names
west loop family medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY WREN (MANAGER)
(432) 580-5966
Entity
Organization
Contact information
Practice address
3001 W UNIVERSITY BLVD, ODESSA, TX 79764-7129
(432) 580-5966
(432) 580-7413
Mailing address
3001 W UNIVERSITY BLVD, ODESSA, TX 79764-7129
(432) 580-5966
(432) 580-7413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00568R
BCBS
TX
Enumeration date
10/16/2006
Last updated
08/22/2020
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