JOHN THOMAS WALLACE

TEMPLE, TX
NPI1376030825
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2085R0202X Radiology, Diagnostic Radiology
(Licence: TX  V3136)
Additional Taxonomies207R00000X Internal Medicine
(Licence: MT  MED-RES-LIC-67472)
2085R0202X Radiology, Diagnostic Radiology
(Licence: AZ  69345)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-04-19
Last Update Date2024-09-23
Business Address
JOHN THOMAS WALLACE
2401 S 31ST ST
TEMPLE, TX 76508-0001
Phone number: 254-724-2111
Mailing Address
JOHN THOMAS WALLACE
PO BOX 844658
DALLAS, TX 75284-4658
Phone number: 800-994-0371