Richard Wallace (NPI# 1083698609, PAC ID# 0446390108) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INFECTIOUS DISEASE.
| Nation Provider ID (NPI) | 1083698609 |
| PAC ID by PECOS | 0446390108 |
| Professional Enrollment ID | I20091211000031 |
| Full Name | Richard Wallace |
| Organization Legal Name | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILITY-PHYSICIAN |
| Address |
102 W Henderson St Ut Health Northeast Overton Overton TX 75684-1613 |
| Phone Number | 9038340201 |
| Gender | M |
| Medical School | BAYLOR COLLEGE OF MEDICINE |
| Graduation Year | 1972 |
| Primary Specialty | INFECTIOUS DISEASE |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 4981699220 |
| Number of Group Practice Members | 100 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 450690 | THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER |
| Address | Phone | Organization |
|---|---|---|
| 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 | 9038340201 | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILITY-PHYSICIAN |
| 11937 Us Hwy 271, Tyler, TX 75708-3154 | 9038777777 | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILITY-PHYSICIAN |
| Organization Legal Name | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER-FACILITY-PHYSICIAN |
| Physicians | 94 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Vincent Oyler | Family Medicine | University of Texas Health Science Center At Tyler-facility-physician | 2808 S Main St, Suite T, Lindale, TX 75771-7855 |
| Soran Anwar Mahmood | Diagnostic Radiology | University of Texas Health Science Center At Tyler-facility-physician | 3310 Patriot Dr, Tyler, TX 75701-6606 |
| Lorena Santoro | Family Medicine | University of Texas Health Science Center At Tyler-facility-physician | 2231 W Gentry Pkwy, Ut Physician Northeast North Tyler, Tyler, TX 75702-2809 |
| Mustapha Ali Khalife | Hematology/oncology | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| Brandon Riley | Psychiatry | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| Michele C Bosworth | Family Medicine | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| Emad E Shoukry | Internal Medicine | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| Samantapudi Daya | Cardiovascular Disease (cardiology) | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| David A Andreone | Podiatry | University of Texas Health Science Center At Tyler-facility-physician | 11937 Us Hwy 271, Tyler, TX 75708-3154 |
| Leo Holm | Family Medicine | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Street Address |
102 W HENDERSON ST UT HEALTH NORTHEAST OVERTON |
| City | OVERTON |
| State | TX |
| Zip | 75684-1613 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leo Holm | Family Medicine | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Jennifer Kaye Fowler | Nurse Practitioner | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Richard Idell | Psychiatry | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Robin Strait | Nurse Practitioner | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Admir Seferovic | Emergency Medicine | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Chiagozie Nwasuruba | Internal Medicine | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Gerald L Brown | Physician Assistant | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Amber Dawson | Internal Medicine | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Cheryl L Houston | Physician Assistant | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Wesley E Pemberton | Family Practice | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James M Hamilton | Family Medicine | 304 N Motley Dr, Overton, TX 75684-1241 | |
| Christiana Osuagwu | Nurse Practitioner | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Overton, TX 75684-1613 |
| Angela Harden | Physician Assistant | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Ut Health Northeast Overton, Overton, TX 75684-1613 |
| Jennifer R Boynton | Nurse Practitioner | University of Texas Health Science Center At Tyler-facility-physician | 102 W Henderson St, Overton, TX 75684-1613 |
| Valarie Johnson | Clinical Social Worker | Senior Psychological Care Dallas I LLC | 1110 State Hwy 135 S, Overton Healthcare Center, Overton, TX 75684-1924 |
| City | OVERTON |
| Zip Code | 75684 |
| Specialty | INFECTIOUS DISEASE |
| City + Specialty | OVERTON + INFECTIOUS DISEASE |
Please comment or provide details below to improve the information on Richard Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.