Individual
THOMAS EVERETT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
740 S LIMESTONE, L543, KENTUCKY CLINIC, LEXINGTON, KY 40536-0284
(859) 323-5045
(859) 257-2418
Mailing address
740 S LIMESTONE, L534, KENTUCKY CLNIC, LEXINGTON, KY 40536-0284
(859) 323-5045
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
43982
KY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
30857
WV
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
43982
KY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD23936
TN
207RP1001X
Pulmonary Disease Physician
30857
WV
207RP1001X
Pulmonary Disease Physician
43982
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201256750
—
IN
05
—
30707611
—
TN
05
—
33270961
—
TN
05
—
3327097
—
TN
01
—
4123936
BCBS OF TENNESSEE
TN
01
—
4158379
BLUE CROSS
TN
01
—
P00317082
RAILROAD MEDICARE
TN
Enumeration date
06/20/2006
Last updated
11/02/2021
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