Individual
WALLACE LOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
612 S 12TH ST, FORT SMITH, AR 72901-4702
(479) 424-3193
Mailing address
111 N 1ST ST, HUGHES, AR 72348-9100
(901) 481-0927
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
67669
TN
207P00000X
Emergency Medicine Physician
E-10064
AR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/14/2015
Last updated
04/04/2024
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