Individual
CHARLES ALAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17110 DALLAS PKWY, SUITE 100, DALLAS, TX 75248-1167
(972) 380-7090
(972) 380-7016
Mailing address
17110 DALLAS PKWY, SUITE 100, DALLAS, TX 75248-1167
(972) 380-7090
(972) 380-7016
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G3885
TX
Other
Enumeration date
07/28/2005
Last updated
07/14/2010
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