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Individual

SCOTT ROBERT WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
103 N LOOP 499, HARLINGEN, TX 78550-2557
(956) 289-7000
(956) 513-0409
Mailing address
1901 S 24TH AVE, EDINBURG, TX 78539-6533
(956) 289-7025
(956) 513-0409

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
BP10059771
TX
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
138708613
TX
Enumeration date
04/07/2017
Last updated
03/26/2019
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