Wallace, Tracy
Wallace, Tracy is an individual health care provider with primary practice located at 1937 S Burnside Ave , Gonzales LA 70737-4632. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallace, Tracy can be contacted via phone (225) 765-5500.Contact Information
Primary practice address
1937 S Burnside Ave
Gonzales LA 70737-4632
Phone: (225) 765-5500
Fax: (225) 644-9286
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 204717 | Louisiana |
Profile Details
| NPI number | 1720306558 |
|---|---|
| LBN Legal business name | Wallace, Tracy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2010 |
| Last updated | May 19th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720306558 | NPPES |
| Louisiana | MEDICAID | 2103831 |
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