Organization
WALLIS DERMATOLOGY ASSOCIATES PLLC
Active
Organization
WALLIS DERMATOLOGY ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BOWEN (CREDENTIALING OFFICER)
(903) 503-7330
Entity
Organization
Contact information
Practice address
3535 N FOURTH ST STE 400, LONGVIEW, TX 75605-0038
(903) 757-3881
(903) 757-5948
Mailing address
3535 N FOURTH ST STE 400, LONGVIEW, TX 75605-0038
(903) 757-3881
(903) 757-5948
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
H6685
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302333501
—
TX
Enumeration date
07/19/2007
Last updated
02/13/2026
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