Individual
MARCUS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15790 PAUL VEGA MD DR, HOSPITAL MEDICINE, HAMMOND, LA 70403-1434
(985) 230-3066
(985) 230-2072
Mailing address
PO BOX 2666, HOSPITAL MEDICINE, HAMMOND, LA 70404-2666
(985) 230-3066
(985) 230-2072
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35540
AZ
207R00000X
Internal Medicine Physician
MD.025294
LA
208M00000X
Hospitalist Physician
Primary
MD.025294
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143374-01
—
AZ
Enumeration date
08/11/2006
Last updated
02/19/2014
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