Organization
GULF COAST RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID RICHARD WALLACE JR. MD (OWNER)
(337) 802-2802
Entity
Organization
Contact information
Practice address
3000 BAYOU BEND RD, LAKE CHARLES, LA 70605-3935
(337) 802-2802
Mailing address
3000 BAYOU BEND RD, LAKE CHARLES, LA 70605-3935
(337) 802-2802
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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