Joe L Wallace, Mdpa

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

JOE L WALLACE, MDPA

Doing business as

west loop family medicine

Practice address

3001 W University Blvd
Odessa, TX 79764-7129

Phone

(432) 580-5966

Fax

(432) 580-7413

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Kathy Wren

Title

Manager

Phone

(432) 580-5966

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• west loop family medicine Doing business as

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881784098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 W UNIVERSITY BLVD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797647129",
            "telephone_number": "432-580-5966",
            "fax_number": "432-580-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W UNIVERSITY BLVD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797647129",
            "telephone_number": "432-580-5966",
            "fax_number": "432-580-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOE L WALLACE, MDPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WREN",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "432-580-5966"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00568R",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "west loop family medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Odessa, TX
• Providers in Odessa, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.