Individual
CORY L WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
8715 VILLAGE DR STE 400, SAN ANTONIO, TX 78217-5407
(210) 732-3668
(210) 732-3338
Mailing address
8715 VILLAGE DR, STE 400, SAN ANTONIO, TX 78217-5407
(210) 732-3668
(210) 732-3338
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
297723YMVU
WMG PTAN
TX
Enumeration date
07/27/2010
Last updated
09/10/2021
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