Individual
RICHARD JAMES WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11937 US HIGHWAY 271, TYLER, TX 75708-3154
(903) 877-7777
Mailing address
PO BOX 731912, DALLAS, TX 75373-1912
(903) 877-7777
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
D9705
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100861704
—
TX
Enumeration date
12/06/2005
Last updated
10/21/2016
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