Individual
DR. TED W WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4007 JAMES CASEY ST STE B200, AUSTIN, TX 78745-1181
(512) 441-9799
Mailing address
203 WALLIS DR, AUSTIN, TX 78746-4637
(512) 329-9459
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E6677
TX
Other
Enumeration date
06/09/2005
Last updated
06/18/2009
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