Individual
DR. DAVID R WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 RYAN ST STE 105, LAKE CHARLES, LA 70601-6078
(337) 439-4706
(337) 439-8110
Mailing address
1800 RYAN ST STE 105, LAKE CHARLES, LA 70601-6078
(337) 439-4706
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A136122
CA
2085R0202X
Diagnostic Radiology Physician
Primary
MD.204718
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2010
Last updated
03/12/2025
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