Individual
REGINALD WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12603 SOUTHWEST FWY, SUITE 335, STAFFORD, TX 77477-3820
(713) 398-7337
Mailing address
3231 TRUESDALE DR, MISSOURI CITY, TX 77459-4947
(713) 398-7337
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02096
TX
Other
Enumeration date
01/08/2013
Last updated
01/08/2013
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