John M. Wallace, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

08491 Issued in MS

Practice address

1203 Jefferson St
Laurel, MS 39440-4354

Phone

(601) 649-2863

Fax

(601) 649-9479

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Practice roles

Interoperability endpoints

• Direct secure messaging: john.wallace@direct.scrmc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Central Regional Sleep Lab

  • Physiological Laboratory
  • Laurel, MS
  • NPI 1275545923
  NPD (past) Authorized official

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373500800000",
    "number": "1174537708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404354",
            "telephone_number": "601-649-2863",
            "fax_number": "601-649-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404354",
            "telephone_number": "601-649-2863",
            "fax_number": "601-649-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2013-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MS",
            "license": "08491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00011285",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latoya Renee Walker, M.D.
• Jon T Wall, CRNA
• Wallace Drug Company Inc
• Wallace Drug Company Inc
• Dedra Danyale Wallace
• Cameron Mackenzie Walley, COTA
• Tabitha Walls, CMHT
• Anna Hendry Walters, FNP-C
• Elizabeth Cori Walters, FNP- C
• Fred Irvin Walters Jr., DDS

• Pulmonary Disease Physician in Laurel, MS
• Providers in Laurel, MS by specialty
• Pulmonary Disease Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; 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.