Mark Kowalski Wallace, M.D

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

01053948A Issued in IN

Practice address

3851 Roger Brooke Dr
Ft Sam Houston
San Antonio, TX 78234

Phone

(210) 916-0775

NPI assigned

Oct 25, 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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1548250103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12443 TECH RIDGE BLVD",
            "address_2": "#712",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78753",
            "telephone_number": "210-818-7958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "address_2": "FT SAM HOUSTON",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-916-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARK",
        "middle_name": "KOWALSKI",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IN",
            "license": "01053948A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse Bryan Wallace, D.C.
• John Wallace
• Kathryn Wallace
• Kimberly Louise Wallace, RN
• Maria Guadalupe Wallace, NP
• Mary Wallace, M.S, LPC
• Melodie Kay Wallace, O.D.
• Norma Leticia Wallace, RN
• Stacy Wallace, NP
• Stacy L Wallace, RD

• Endocrinology, Diabetes & Metabolism Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Endocrinology, Diabetes & Metabolism Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.