Individual
DR. CHRISTOPHER L. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 743-0024
(210) 702-6274
Mailing address
PO BOX 734812, DALLAS, TX 75373-4812
(210) 358-9500
(210) 358-9183
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L0680
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045039701
—
TX
Enumeration date
08/01/2006
Last updated
02/08/2021
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