45D0684764 CLIA NUMBER - WALLIS DERMATOLOGY ASSOCIATES PLLC

Laboratory Demographics

  • CLIA Code: 45D0684764
  • Facility Name: WALLIS DERMATOLOGY ASSOCIATES PLLC
  • Facility Address: 3535 NORTH 4TH STREET, SUITE 400
    LONGVIEW, TX
    ZIP 75605
  • Facility Phone: 903 757-3881
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MARK S. WALLIS
  • NPI Number: 1396945234
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 45D0684764
LAB Type Physician Office
Facility Name WALLIS DERMATOLOGY ASSOCIATES PLLC
Street 3535 NORTH 4TH STREET, SUITE 400
City LONGVIEW
State TX
ZIP 75605
Phone 903 757-3881
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Physician Office
Lab Director MARK S. WALLIS

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This page was last updated on: 9/29/2025