MEDICARE: DR. ALEC WALLACE MD

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	207P00000X	Emergency Medicine Physician	W3062	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1306533674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEC WALLACE MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BOULEVARD DALLAS TEXAS 75390
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BOULEVARD DALLAS TEXAS 75390
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-0001
Country	:	US
Telephone Number	:	214-786-4829
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	01/26/2026

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Directions to “ DR. ALEC WALLACE MD” Practice Location

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