Individual
MR. GREGORY SCOTT WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1204 N MOUND ST, NACOGDOCHES, TX 75961-4027
(936) 568-8444
Mailing address
106 COUNTY ROAD 253, NACOGDOCHES, TX 75965-6980
(936) 554-7297
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
630401
TX
Other
Enumeration date
01/23/2007
Last updated
11/04/2014
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