Arthur G Wallace Jr., DO

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

1864 Issued in OK

Practice address

1717 S Utica Ave Ste a
Tulsa, OK 74104-5346

Phone

(918) 748-7557

Fax

(918) 748-7514

NPI assigned

Oct 12, 2005

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 Osteopathy

Practice roles

Interoperability endpoints

• FHIR API: https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4

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.

• Ahs Oklahoma Physician Group LLC

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1235182775
  NPD (past)
• Southcrest Emergency Physicians PC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Tulsa, OK
  • NPI 1205816048
  NPD (past)
• Sterling Emergency Services of Oklahoma, Inc.

  • Nurse Practitioner
  • Tulsa, OK
  • NPI 1366480295
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271116800000",
    "number": "1225026206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N HARVARD AVE",
            "address_2": "STE E",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741154957",
            "telephone_number": "918-832-6049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S UTICA AVE STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045346",
            "telephone_number": "918-748-7557",
            "fax_number": "918-748-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ARTHUR",
        "middle_name": "G",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2010-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OK",
            "license": "1864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100228470B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Wall, NP-C
• Adam Joseph Wallace, M.D.
• Alexa Nicole Wallace, MS, RD, LD
• Alyssa Ann Wallace
• Annette S. Wallace, LPC
• Carrie Wallace
• Christa Wallace
• Dacia Lanora Wallace
• Diana Lynn Wallace, R.D. L.D.
• Emily Marissa Wallace

• Emergency Medical Services (Emergency Medicine) Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; 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.