Kody Wallace

NPI 1912061607 · on the registry since 2006 · sole proprietor

Practice

Address: 400 Sw 25th Ave
Mineral Wells, TX 76067
Phone: (940) 328-6580
Fax: (940) 328-6550
Organisation at this address: Palo Pinto General Hospital
Texas Em-1 Medical Services, Pa
Palo Pinto Emergency Physicians
Palo Pinto County Hospital District
Palo Pinto County Hospital District
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 19

Registry record

Primary taxonomy: 225100000X
225100000X
Licence states on file: TX
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2007-07-08

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