MEDICARE: WILLIAM E WALLACE DO

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	208600000X	Surgery Physician	F7282	TX
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	F7282	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8GH312	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1225087562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM E WALLACE DO

Provider Business Mailing Address
First Line	:	PO BOX 2078
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-6156
Country	:	US
Telephone Number	:	817-380-6621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 BEN MERRITT DR
Second Line	:	SUITE B
City	:	DECATUR
State	:	TX
Zip	:	76234-3848
Country	:	US
Telephone Number	:	817-380-6621
Fax Number	:	817-380-6622

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/21/2022

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Directions to “ WILLIAM E WALLACE DO” Practice Location

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