Wallis, Jack Wesley

Wallis, Jack Wesley is an sole proprietor health care provider with primary practice located at 2108 Hunter Rd Suite 116, San Marcos TX 78666-5156. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Wallis, Jack Wesley can be contacted via phone (512) 754-7700.

Contact Information

Primary practice address
2108 Hunter Rd Suite 116 San Marcos TX 78666-5156
Phone: (512) 754-7700
Fax: (512) 754-0012
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G8488 Texas
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X G8488 Texas

Profile Details

NPI number 1962484733
LBN Legal business name Wallis, Jack Wesley
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 17th, 2005
Last updated Sep 14th, 2010 - about 14 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 1962484733 NPPES
Texas MEDICAID 122902302

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