Wallace, David Richard

Wallace, David Richard is an individual health care provider with primary practice located at 2903 1St Ave , Lake Charles LA 70601-8809. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Wallace, David Richard can be contacted via phone (337) 478-6480.

Contact Information

Primary practice address
2903 1St Ave Lake Charles LA 70601-8809
Phone: (337) 478-6480
Fax: (337) 474-9637
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 015614 Louisiana

Profile Details

NPI number 1619968146
LBN Legal business name Wallace, David Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619968146 NPPES
Louisiana MEDICAID 1329762

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