Individual
DR. JAMES EDWARDS WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1135 EXPRESSWAY DR, SUITE 200 A, PINEVILLE, LA 71360-6698
(318) 561-9600
(318) 561-0228
Mailing address
1135 EXPRESSWAY DR, SUITE 200 A, PINEVILLE, LA 71360-6698
(318) 561-9600
(318) 561-0228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.200134
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1627950
—
LA
01
—
202768397
HUMANA
LA
Enumeration date
05/17/2006
Last updated
06/19/2014
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