CORY L WALLACE (NPI# 1780998112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780998112 |
| Entity Type | Individual |
| Full Name | CORY L WALLACE |
| Other Name | CORY WELLS |
| Credential | DPM |
| Practice Address |
4330 Medical Dr Ste 500 San Antonio TX 78229-3342 |
| Mailing Address |
8715 Village Dr Ste 400 San Antonio TX 78217-5407 |
| Practice Telephone | 2107323668 |
| Practice Fax Number | 2107323338 |
| Mailing Telephone | 2107323668 |
| Mailing Fax Number | 2107323338 |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2017-04-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
2047 | TX | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | WMG PTAN | 297723YMVU | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972103745 | Cory Wallace | Pharmacist | 2301 W Kenosha St, Broken Arrow, OK 74012-8912 | 2020-10-29 |
| 1447740238 | Cory Alexis Wallace | Behavior Technician | 5801 Ne Cornelius Pass Rd, Hillsboro, OR 97124-9370 | 2018-05-16 |
| Street Address |
4330 MEDICAL DR STE 500 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78229-3342 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689679151 | Patrick A Hartsell | Surgery | 4330 Medical Dr, Ste 120, San Antonio, TX 78229-3342 | 2005-06-20 |
| 1003359548 | Crystal Marlen Montes | Nurse Practitioner | 4330 Medical Dr, Suite 120, San Antonio, TX 78229-3342 | 2016-12-01 |
| 1962956540 | Lisa Mozejko | Physician Assistant | 4330 Medical Dr, Suite 325, San Antonio, TX 78229-3342 | 2016-08-11 |
| 1992140032 | Lashandra L. Royster- Adams | Hospitalist | 4330 Medical Dr, Ste 500, San Antonio, TX 78229-3318 | 2013-05-02 |
| 1427312065 | Adriana E. Suarez | Hospitalist | 4330 Medical Dr, Suite 500, San Antonio, TX 78229-3342 | 2012-06-28 |
| 1356604151 | Ashwin Gopal Prabhu | Internal Medicine | 4330 Medical Dr, Suite 500, San Antonio, TX 78229-3342 | 2012-06-18 |
| 1639447071 | Diogenes Ivan Valderrama Torres | Internal Medicine | 4330 Medical Dr, Ste 500, San Antonio, TX 78229-3342 | 2011-12-13 |
| 1457634289 | Melody R Verner | Nurse Practitioner | 4330 Medical Dr, Suite 500, San Antonio, TX 78229-3342 | 2011-09-28 |
| 1154602514 | Le'jon P Teran | Nurse Practitioner | 4330 Medical Dr, Ste 500, San Antonio, TX 78229-3342 | 2011-08-30 |
| 1649559824 | Jennifer Marie Delao | Registered Nurse | 4330 Medical Dr, Ste 120, San Antonio, TX 78229-3342 | 2011-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245857226 | Lyndsey A Sandoval | Optometrist | 7400 Minton Miner St, San Antonio, TX 78229 | 2020-06-25 |
| 1295355311 | Nicolet Finger | Student in an Organized Health Care Education/Training Program | 7703 Floyd Curl Drive, Mc 7798, San Antonio, TX 78229 | 2020-04-18 |
| 1215557400 | Amy Elizabeth Werry | Clinical Neuropsychologist | 7703 Floyd Circle Drive, San Antonio, TX 78229 | 2020-04-17 |
| 1740822972 | Mohammad Safaie Yazdi | Student in an Organized Health Care Education/Training Program | Ut Health Science Center At San Antonio- Agdc, 8210 Floyd Curl Dr., Msc 8103, San Antonio, TX 78229 | 2019-10-09 |
| 1063053072 | Blas Edward Villa | Nurse Practitioner | 7703 Floyd Curl Drive Mc 7885 Pulmonary Diseases & Crit, Medicine, San Antonio, TX 78229 | 2019-10-01 |
| 1124673942 | Integrity Dme Services LLC | Durable Medical Equipment & Medical Supplies | 6323 Sovereign Dr, Suite # 170 Ab, San Antonio, TX 78229 | 2019-08-08 |
| 1730734120 | Marisa Erin Leyden | Speech-Language Pathologist | Joe R. & Teresa Lozano Long Campus, 7703 Floyd Curl Dr., San Antonio, TX 78229 | 2019-08-03 |
| 1285295741 | Alireza Ghezavati | Student in an Organized Health Care Education/Training Program | 7703 Floyd Curl Drive Mc 7750, Department of Pathology and Laboratory Medicine, San Antonio, TX 78229 | 2019-06-25 |
| 1407410285 | Denae Cheyenne Rushing | Student in an Organized Health Care Education/Training Program | 8201 Floyd Curl Drive, San Antonio, TX 78229 | 2019-04-26 |
| 1265993570 | Shehzad Amlani | Student in an Organized Health Care Education/Training Program | Address: 7703 Floyd Curl Dr, San Antonio, TX 78229 | 2019-03-28 |
| Find all providers in zip 78229 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417446642 | South Alamo Foot & Ankle Pllc | Podiatrist | 102 Palo Alto Rd Ste 133, San Antonio, TX 78211-3792 | 2018-05-03 |
| 1467803064 | Preston John Panicco | Podiatrist | 14615 San Pedro Ave Ste 160, San Antonio, TX 78232-4364 | 2016-06-24 |
| 1114367968 | Elaine Danial | Podiatrist | 4334 N Loop 1604 W Ste 102, San Antonio, TX 78249-3485 | 2013-06-26 |
| 1467772863 | Ruben Jordan Mechell | Podiatrist | 3303 Rogers Rd Ste 230, San Antonio, TX 78251 | 2010-06-08 |
| 1639336746 | Russell Stanley | Podiatrist | 8042 Wurzbach Rd Ste 450, Physicians Plaza II, San Antonio, TX 78229-3808 | 2008-05-18 |
| 1780867754 | Michael R. Langlois | Podiatrist | 701 S Zarzamora St # Sr, San Antonio, TX 78207-5209 | 2007-12-12 |
| 1467634121 | Sean L. Kersh | Podiatrist | 8603 N Loop 1604 W, Apartment #8106, San Antonio, TX 78249-2601 | 2007-12-04 |
| 1720268741 | Moffatt David Adams Jr. | Podiatrist | 18585 Sigma Rd Ste 104, San Antonio, TX 78258 | 2007-11-07 |
| 1609075902 | Eddie Davis | Podiatrist | 109 Gallery Cir Ste 119, Suite 119, San Antonio, TX 78258-3328 | 2007-07-16 |
| 1528117140 | Walter William Strash | Podiatrist | 7424 Broadway St, San Antonio, TX 78209-3254 | 2007-01-10 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78229 |
Please comment or provide details below to improve the information on CORY L WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.