| Erin Elizabeth Wallace, MD | |
|
252 Matlock Rd Ste 330, Mansfield, TX 76063-4294 | |
| (817) 557-5437 | |
| (817) 539-0476 |
| Full Name | Erin Elizabeth Wallace |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 252 Matlock Rd Ste 330, Mansfield, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396952263 | NPI | - | NPPES |
| 195476005 | Medicaid | TX | |
| 197051902 | Medicaid | TX | |
| 197051904 | Medicaid | TX | |
| 084933301 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | M9077 (Texas) | Primary |
| Entity Name | Medical Clinic Of North Texas, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033167234 PECOS PAC ID: 9830084540 Enrollment ID: O20040430001258 |
| Entity Name | Dallas Physician Medical Services For Children Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1194153650 PECOS PAC ID: 1759607906 Enrollment ID: O20150305000673 |
| Mailing Address | Practice Location Address |
|---|---|
| Erin Elizabeth Wallace, MD 252 Matlock Rd Ste 330, Mansfield, TX 76063-4294 Ph: (817) 557-5437 | Erin Elizabeth Wallace, MD 252 Matlock Rd Ste 330, Mansfield, TX 76063-4294 Ph: (817) 557-5437 |
Katrina L Willie-musoma, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2800 E Broad St Ste 100, Mansfield, TX 76063 Phone: 817-557-5437 Fax: 817-539-0476 | |
Clive G Daniels, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 | |
Julie Hong, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1759 Broad Park Circle S, Suite 201 And 205, Mansfield, TX 76063 Phone: 682-341-3910 Fax: 682-400-1288 | |
Matthew Raymond Lussier, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 | |
Linda K Phan, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 252 Matlock Rd Ste 300, Mansfield, TX 76063 Phone: 817-557-5473 Fax: 817-539-0476 | |
Melvin T Joki, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 | |
Robert W Mann, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 Matlock Rd, Mansfield, TX 76063 Phone: 817-453-5437 Fax: 817-453-2714 |