Individual
DR. JEANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4426
(214) 345-6789
Mailing address
7557 RAMBLER RD, SUITE 706, DALLAS, TX 75231-4142
(214) 369-0800
(214) 378-5311
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G4871
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131346201
—
TX
05
—
131346204
—
TX
Enumeration date
12/21/2005
Last updated
02/17/2012
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