Organization
JAMES E. WALLACE, JR, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA DEWITT BAILEY CPC (OFFICE MANAGER)
(318) 561-9600
Entity
Organization
Contact information
Practice address
1135 EXPRESSWAY DR, SUITE 200 A, PINEVILLE, LA 71360-6698
(318) 561-9600
(318) 561-0228
Mailing address
1135 EXPRESSWAY DR, SUITE 200 A, PINEVILLE, LA 71360-6698
(318) 561-9600
(318) 561-0228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.200134
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1627950
—
LA
Enumeration date
07/26/2007
Last updated
11/14/2007
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