Individual
ERIN ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M9077
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084933301
—
TX
05
—
195476005
—
TX
05
—
197051902
—
TX
05
—
197051904
—
TX
Enumeration date
05/17/2007
Last updated
11/04/2019
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