Scott Robert Wallace

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

BP10059771 Issued in TX

Practice address

103 N Loop 499
Harlingen, TX 78550-2557

Phone

(956) 289-7000

Fax

(956) 513-0409

NPI assigned

Apr 7, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1104359975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S 24TH AVE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785396533",
            "telephone_number": "956-289-7025",
            "fax_number": "956-513-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N LOOP 499",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785502557",
            "telephone_number": "956-289-7000",
            "fax_number": "956-513-0409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 S 24th Ave",
            "address_purpose": "LOCATION",
            "city": "Edinburg",
            "state": "TX",
            "postal_code": "785396533",
            "country_code": "US",
            "telephone_number": "956-289-7025",
            "fax_number": "956-513-0409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SCOTT",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-07",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "BP10059771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138708613",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co.
• Walgreens
• Walgreens
• Brian Bernard Walker, CRNA
• Thelma Yvonne Escalon Walker
• Jay R Walther, MD
• Abali Wandala, MD
• Jonathan Warden, PHARMD
• Warm Smiles PC
• Laura Waters, RN

• Psychiatry Physician in Harlingen, TX
• Providers in Harlingen, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.