Individual
DAVID MICHAEL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
22001 SOUTHWEST FWY STE 300, RICHMOND, TX 77469-7001
(281) 633-4940
(281) 633-4943
Mailing address
4911 SANDHILL DR, SUGAR LAND, TX 77479-5320
(281) 238-7870
(281) 633-4985
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34-008872
OH
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
N0539
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8BL970
BLUE CROSS BLUE SHIELD TX
TX
Enumeration date
07/26/2007
Last updated
02/27/2020
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