Individual
BRIAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1910 ROSELAND BLVD, TYLER, TX 75701-4246
(903) 533-0644
Mailing address
1910 ROSELAND BLVD, TYLER, TX 75701-4246
(903) 533-0644
(903) 533-0441
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN 169685C
CO
Other
Enumeration date
05/23/2007
Last updated
03/12/2010
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