Individual
WILLIAM E WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2000 BEN MERRITT DR, SUITE B, DECATUR, TX 76234-3848
(817) 380-6621
(817) 380-6622
Mailing address
PO BOX 2078, DECATUR, TX 76234-6156
(817) 380-6621
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
F7282
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
F7282
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115246411
—
TX
01
—
8GH312
BCBSTX
TX
Enumeration date
05/06/2006
Last updated
07/21/2022
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