Individual
HENRY C. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 SOUTHRIDGE BLVD STE A, HEBER SPRINGS, AR 72543
(501) 206-0176
(501) 206-0179
Mailing address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204-1720
(501) 604-6900
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
N4831
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188382001
—
AR
01
—
1922327485
NPI
AR
Enumeration date
05/24/2010
Last updated
01/11/2019
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