James E. Wallace, Jr, M.D., LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD.200134 Issued in LA

Legal business name

JAMES E. WALLACE, JR, M.D., LLC

Practice address

1135 Expressway Dr
Suite 200 a
Pineville, LA 71360-6698

Phone

(318) 561-9600

Fax

(318) 561-0228

NPI assigned

Jul 26, 2007

Last updated

Nov 14, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tina Dewitt Bailey, CPC

Title

Office Manager

Phone

(318) 561-9600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Robert Morris, MD

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1861468068
  NPD (past)

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1568652485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 EXPRESSWAY DR",
            "address_2": "SUITE 200 A",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713606698",
            "telephone_number": "318-561-9600",
            "fax_number": "318-561-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 EXPRESSWAY DR",
            "address_2": "SUITE 200 A",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713606698",
            "telephone_number": "318-561-9600",
            "fax_number": "318-561-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES E. WALLACE, JR, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "DEWITT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-561-9600",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.200134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1627950",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danny J. Jackson Sr., P.D.
• Keatrina Marie Jackson, RPH
• Kenneth Karl Jackson, RRT
• Robin Caprice Jackson
• Samia Jada
• Amber M James, FNP-C
• Amy Jameson, O.T.
• Chad Jameson
• Judy Anne Jameson, RN, MSN, C-FNP
• Kelly D Jaubert, PHARMD

• Family Medicine Physician in Pineville, LA
• Providers in Pineville, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.