Individual
DR. WALLACE LEE TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1940 S WHITEHEAD DR, DE WITT, AR 72042-2906
(870) 946-4505
(870) 946-2428
Mailing address
245 MADISON ST, CLARENDON, AR 72029-2706
(870) 747-1400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C7340
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114942001
—
AR
Enumeration date
09/26/2005
Last updated
03/05/2026
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