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NPI Code Detail

MEDICARE: MR. MORGAN WILLIAM WALLACE

MEDICARE: MR. MORGAN WILLIAM WALLACE
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
1390200000XStudent in an Organized Health Care Education/Training Program39646433TX

General Provider Information

NPI Number : 1407703713
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MORGAN WILLIAM WALLACE
Provider Business Mailing Address
First Line : 925 CITY CENTRAL AVE
Second Line :
City : CONROE
State : TX
Zip : 77304-2981
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 925 CITY CENTRAL AVE
Second Line :
City : CONROE
State : TX
Zip : 77304-2981
Country : US
Telephone Number : 936-202-5202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ MR. MORGAN WILLIAM WALLACE ” Practice Location

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