William R Wallace, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

H9585 Issued in TX

Practice address

1809 Capital Dr
Tyler, TX 75701-8438

Phone

(903) 509-4499

Fax

(903) 509-4490

NPI assigned

Jun 14, 2006

Last updated

Apr 2, 2010By the provider in NPPES

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 2

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tyler Urgent Care LLP

  • Emergency Medicine Physician
  • Tyler, TX
  • NPI 1053442368
  NPD

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270166400000",
    "number": "1962445825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 CAPITAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018438",
            "telephone_number": "903-509-4499",
            "fax_number": "903-509-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 CAPITAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018438",
            "telephone_number": "903-509-4499",
            "fax_number": "903-509-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2010-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "H9585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139484314",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0076EJ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kacey Wallace
• Michael Shawn Wallace, PHARMACIST
• Naomi Susan Wallace, NP
• Richard James Wallace Jr., MD
• Tina Gayle Wallace
• Jessica Crosby Waller, MSCN
• Chelsea Walling, LMFT ASSOCIATE
• Stephen Walling, MD
• Reagan Walls, MSN, APRN, FNP-C
• Ellen Stockton Walraven, M.D.

• Emergency Medicine Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2010; 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.