Individual
DR. BRENT H WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
141 HYDE PARK BLVD, CLEBURNE, TX 76033-4561
(817) 641-5221
(817) 517-5241
Mailing address
141 HYDE PARK BLVD, CLEBURNE, TX 76033-4561
(817) 641-5221
(817) 517-5241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
F2093
TX
Other
Enumeration date
09/07/2005
Last updated
07/08/2007
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