Individual
DR. ERIC LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
145 W 4TH ST STE 201, COOKEVILLE, TN 38501-2476
(931) 783-5515
(931) 783-5513
Mailing address
140 W 7TH ST, COOKEVILLE, TN 38501-1726
(931) 783-5515
(931) 783-5513
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
71205
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q096326
—
TN
Enumeration date
07/04/2006
Last updated
10/14/2025
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