Wallace, Erin Elizabeth

Wallace, Erin Elizabeth is an individual health care provider with primary practice located at 252 Matlock Rd Ste 330 , Mansfield TX 76063-4294. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallace, Erin Elizabeth can be contacted via phone (817) 557-5437.

Contact Information

Primary practice address
252 Matlock Rd Ste 330 Mansfield TX 76063-4294
Phone: (817) 557-5437
Fax: (817) 539-0476
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X M9077 Texas

Profile Details

NPI number 1396952263
LBN Legal business name Wallace, Erin Elizabeth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Nov 4th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396952263 NPPES
Texas MEDICAID 195476005
Texas MEDICAID 197051902
Texas MEDICAID 197051904
Texas MEDICAID 084933301

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