Individual
RICHARD LEE WALLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2715 BOLTON BOONE, SUITE A, DESOTO, TX 75115
(972) 296-0086
(972) 298-5536
Mailing address
2715 BOLTON BOONE, SUITE A, DESOTO, TX 75115
(972) 296-0086
(972) 298-5536
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
F7283
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00FH64
BCBS
TX
Enumeration date
01/09/2007
Last updated
07/08/2007
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