Lewis Alfred Wallace, DO

NPI #1942292271 in Ada, Oklahoma

Provider Information

NPI Number: 1942292271
Entity Type: Individual
Name: Lewis Alfred Wallace, DO
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Internal Medicine
Credential: DO
Enumeration Date: Aug 23, 2005
Last Updated: Sep 14, 2016

Practice Location

Address: 1921 STONECIPHER BLVD
City: Ada
State: Oklahoma
ZIP Code: 74820
Phone: (580) 421-4570

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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