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Search › Texas › 207ND0101X

Mark Wallis, M.D

NPI 1861489049 · on the registry since 2005 · sole proprietor

Practice

Address
3535 N Fourth St Ste 400
Longview, TX 75605
Phone
(903) 757-3881
Fax
(903) 757-5948
Organisation at this address
Scott Distefano Dds Pllc
East Texas Kidney Specialists,Pa
Wallis Dermatology Associates Pllc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
18

Registry record

Primary taxonomy
207ND0101X
207ND0101X
Also registered as
207N00000X
207ND0900X
207NI0002X
207NP0225X
207NS0135X
Licence states on file
TX
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2023-03-07

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas