Individual
AUSTIN H WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8080 BLUEBONNET BLVD STE 1000, BATON ROUGE, LA 70810-7827
(225) 924-2424
(225) 408-7965
Mailing address
8080 BLUEBONNET BLVD STE 1000, BATON ROUGE, LA 70810-7827
(225) 924-2424
(225) 408-7965
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
312099
LA
Other
Enumeration date
04/12/2019
Last updated
04/12/2019
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