MEDICARE: DR. JAMES ORAN WALLACE M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	F7955	TX

General Provider Information

NPI Number	:	1053395822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ORAN WALLACE M. D.

Provider Business Mailing Address
First Line	:	6624 FANNIN ST
Second Line	:	SUITE 2400
City	:	HOUSTON
State	:	TX
Zip	:	77030-2312
Country	:	US
Telephone Number	:	713-790-9151
Fax Number	:	713-790-0927

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST
Second Line	:	SUITE 2400
City	:	HOUSTON
State	:	TX
Zip	:	77030-2312
Country	:	US
Telephone Number	:	713-790-9151
Fax Number	:	713-790-0927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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