Organization
WALLACE SPORTS MEDICINE PA
Active
Other names
Wallace Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WALLACE MD (PRESIDENT)
(972) 722-4830
Entity
Organization
Contact information
Practice address
2313 RIDGE RD STE 105B, ROCKWALL, TX 75087-5141
(972) 722-4830
Mailing address
8440 WALNUT HILL LN, SUITE 120, DALLAS, TX 75231-3833
(214) 506-2610
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
02/20/2013
Last updated
03/27/2013
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