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NPI Code Detail

MEDICARE: DR. LARS ERIK WALLIN III MD

MEDICARE: DR. LARS ERIK WALLIN III 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
1208800000XUrology Physician73340TN

General Provider Information

NPI Number : 1821434457
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARS ERIK WALLIN III MD
Provider Business Mailing Address
First Line : 1325 WOLF PARK DR STE 103
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-1759
Country : US
Telephone Number : 901-252-3500
Fax Number : 901-763-4305
Provider Business Practice Location Address
First Line : 1325 WOLF PARK DR STE 102
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-1759
Country : US
Telephone Number : 901-252-3400
Fax Number : 901-763-4305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2013
Last Update Date : 12/02/2025

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