Provider Demographics
NPI:1053395822
Name:WALLACE, JAMES ORAN (M D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ORAN
Last Name:WALLACE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-790-9151
Mailing Address - Fax:713-790-0927
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-790-9151
Practice Address - Fax:713-790-0927
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MP22Medicare ID - Type Unspecified
TXC23111Medicare UPIN