Individual
MARK LYNN WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1728 S CARSON AVE, TULSA, OK 74119-4610
(918) 406-3420
Mailing address
2701 S JUNIPER AVE APT 102, BROKEN ARROW, OK 74012-7731
(918) 888-0220
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/20/2026
Last updated
04/03/2026
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