National Provider Identifier Database

MARK S WALLIS, MD – NPI #1861489049
MOHS-Micrographic Surgery

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.


Contact Information

MARK S WALLIS, MD
3535 N FOURTH ST STE 400
LONGVIEW, TX75605-0038
Phone: 903-757-3881
Fax: 903-757-5948
Website:
Specialty Taxonomy Code
* MOHS-Micrographic Surgery 207ND0101X
Clinical & Laboratory Dermatological Immunology 207NI0002X
Dermatology 207N00000X
Dermatopathology 207ND0900X
Pediatric Dermatology 207NP0225X
Procedural Dermatology 207NS0135X

* Indicates primary specialty

NPI Profile & details for MARK S WALLIS

NPI Number 1861489049
Credentials MD
Entity Individual
Enumeration date 10/03/2005
Last updated 03/07/2023 - About 3 years ago
Sole proprietor1 Yes
Identifiers
  • TX License #: H6685
  • TX Medicaid: 0898678-03
  • TX Other: CID037095 CIDC NUMBER
  • TX Other: 45D0684764 CLIA NUMBER
  • TX Other: 30076724 DPS NUMBER
  • TX Other: 04813881913 MED. ED. NUMBER
  • TX Other: H6685 MEDICAL LICENSE NUMBER
Hospital affiliation n/a

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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