Brent H Wallace, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

F2093 Issued in TX

Practice address

141 Hyde Park Blvd
Cleburne, TX 76033-4561

Phone

(817) 641-5221

Fax

(817) 517-5241

NPI assigned

Sep 7, 2005

Reactivated

Apr 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/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.

• Cleburne Internal Medicine Associates, PA

  • Internal Medicine Physician
  • Cleburne, TX
  • NPI 1629162805
  NPD (past) Authorized official
• Medical Clinic of North Texas PLLC

  • Radiation Oncology Clinic/Center
  • Arlington, TX
  • NPI 1184131625
  NPD (past)

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386638252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 HYDE PARK BLVD",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334561",
            "telephone_number": "817-641-5221",
            "fax_number": "817-517-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 HYDE PARK BLVD",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334561",
            "telephone_number": "817-641-5221",
            "fax_number": "817-517-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRENT",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2007-07-08",
        "deactivation_date": "2006-03-24",
        "reactivation_date": "2006-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "F2093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mustafa Wafayee, NP
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas, LP
• Walgreen Co
• Jonathan Alan Walker, M.D.
• Walls Regional Hospital
• Britni Warren
• Lonmontre Washington, LMT
• Dorothy J Watson, APRN, FNP-C
• Edward Clarkson Waymire, ATP, CRTS

• Internal Medicine Physician in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.