Individual
JOHN THOMAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MED-RES-LIC-67472
MT
2085R0202X
Diagnostic Radiology Physician
69345
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
V3136
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2018
Last updated
09/23/2024
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