| James E. Wallace, Jr, M.d., Llc | |
|
1135 Expressway Dr Suite 200 A Pineville LA 71360-6698 | |
| (318) 561-9600 | |
| (318) 561-0228 |
| Full Name | James E. Wallace, Jr, M.d., Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1135 Expressway Dr, Pineville, Louisiana |
| Authorized Official Name and Position | Tina Dewitt Bailey (OFFICE MANAGER) |
| Authorized Official Contact | 3185619600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James E. Wallace, Jr, M.d., Llc 1135 Expressway Dr Suite 200 A Pineville LA 71360-6698 Ph: (318) 561-9600 | James E. Wallace, Jr, M.d., Llc 1135 Expressway Dr Suite 200 A Pineville LA 71360-6698 Ph: (318) 561-9600 |
| NPI Number | 1568652485 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 11/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568652485 | NPI | - | NPPES |
| 1627950 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD.200134 (Louisiana) | Primary |
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