CHARLES ALAN WALLACE MD NPI 1164422481

NPI Information

Charles Alan Wallace, MD is a plastic and reconstructive surgery surgery in Dallas, TX with 42 years of experience. The provider is a surgeon who specializes in plastic and reconstructive surgery. Charles Alan Wallace, MD NPI is 1164422481. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Graduation Year:1982

The provider's business location address is:

17110 DALLAS PKWY
SUITE 100
DALLAS, TX
ZIP 75248-167
Phone: (972) 380-7090
Fax: (972) 380-7016

The NPI 1164422481 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/28/2005 and was last updated on 7/14/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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