Individual
DR. DANIEL THEODORE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7832 PAT BOOKER RD, LIVE OAK, TX 78233-2601
(210) 657-9338
Mailing address
7832 PAT BOOKER RD, LIVE OAK, TX 78233-2601
(210) 657-9338
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
S7577
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP10056054
TX
Other
Enumeration date
04/13/2016
Last updated
08/11/2021
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