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General NPI Number Information
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NPI Number | 1437349479
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Entity Type | Individual
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Provider Name | DAVID MICHAEL WALLACE D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 22001 SOUTHWEST FWY STE 300
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City | RICHMOND
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State | TX
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Zip | 77469-7001
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Country | US
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Telephone | 281-633-4940
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Fax | 281-633-4943
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Provider Business Mailing Address
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Address Line | 4911 SANDHILL DR
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City | SUGAR LAND
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State | TX
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Zip | 77479-5320
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Country | US
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Telephone | 281-238-7870
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Fax | 281-633-4985
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34-008872
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | N0539
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License Number State | TX
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