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WILLIAM R WALLACE MD NPI 1962445825


NPI Profile

NPI: 1962445825
Provider Name: WILLIAM R WALLACE, MD
Classification:Emergency Medicine - 207P00000X
Entity Type: Individual
Organization: CEC TYLER ER PHYSICIANS PLLC

PECOS Registration: Yes

Address:
1809 CAPITAL DR
TYLER, TX
ZIP 75701
Get Directions

Phone: (903) 509-4499

William R Wallace, MD is an emergency medicine in Tyler, TX with 32 years of experience. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. William R Wallace, MD NPI is 1962445825. 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 MEDICAL BRANCH AT GALVESTON
Graduation Year:1989

The provider's business location address is:

1809 CAPITAL DR
TYLER, TX
ZIP 75701-438
Phone: (903) 509-4499
Fax: (903) 509-4490

The NPI 1962445825 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 6/14/2006 and was last updated on 4/2/2010.


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:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207P00000XEmergency MedicineH9585TEXASYes

Other Identifiers

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

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10076EJOTHERTEXASBCBS
2E88168MEDICARE UPINTEXAS
300H88FMEDICARE PINTEXAS
4930089208MEDICARE PINTEXAS
5139484314MEDICAIDTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 9/12/2021

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.