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Contact Information

LEWIS A WALLACE, DO
1921 STONECIPHER BLVD
ADA, OK74820
 Phone: 580-421-4570
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for LEWIS A WALLACE · (Male)

NPI Number 1942292271
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 08/23/2005
Last updated 09/14/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • OK License # 3060
Hospital affiliation(s)
  • CHICKASAW NATION MEDICAL CENTER - (Acute Care)
    1921 STONECIPHER BLVD
    ADA, OK 74820
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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