Wallis, Mark S
Wallis, Mark S is an sole proprietor health care provider with primary practice located at 3535 N Fourth St Ste 400 , Longview TX 75605-0038. He recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Wallis, Mark S can be contacted via phone (903) 757-3881.Contact Information
Primary practice address
3535 N Fourth St Ste 400
Longview TX 75605-0038
Phone: (903) 757-3881
Fax: (903) 757-5948
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | H6685 | Texas |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | H6685 | Texas |
| Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology | 207NI0002X | H6685 | Texas |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | H6685 | Texas |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | H6685 | Texas |
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | H6685 | Texas |
Profile Details
| NPI number | 1861489049 |
|---|---|
| LBN Legal business name | Wallis, Mark S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 3rd, 2005 |
| Last updated | Mar 7th, 2023 - about last year |
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 | 1861489049 | NPPES |
| Texas | Other | 30076724 | DPS NUMBER |
| Texas | Other | 45D0684764 | DPS NUMBER |
| Texas | Other | CID037095 | DPS NUMBER |
| Texas | Other | H6685 | DPS NUMBER |
| Texas | Other | 04813881913 | DPS NUMBER |
| Texas | MEDICAID | 0898678-03 | DPS NUMBER |
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