Charles Alan Wallace
Plastic and Reconstructive Surgery
17110 Dallas Pkwy Suite 100
Dallas
, Texas 75248-1167
Charles Alan Wallace
Plastic and Reconstructive Surgery
17110 Dallas Pkwy Suite 100
Dallas
, Texas 75248-1167
(972) 380-7016
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Charles Alan Wallace
- 17110 Dallas Pkwy Suite 100
- Dallas, TX
- Zip : 75248-1167
- Fax : (972) 380-7016
- Phone : (972) 380-7090
Second Address
- Charles Alan Wallace
- 17110 Dallas Pkwy Suite 100
- Dallas, TX
- Zip : 75248-1167
- Fax : (972) 380-7016
- Phone : (972) 380-7090
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | G3885 | TX |
National Provider Identifier
| NPI | 1164422481 |
|---|---|
| Provider Name | Charles Alan Wallace |
| First Address | Dallas, TX 75248-1167 |
| Second Address | Dallas, TX 75248-1167 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/07/2005 |
| Last Update Date | 14/07/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| C23118 | (02) | TX |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.