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Contact Information

PATRICK J WALLACE, MD
2240 GULF FWY S STE 2.100
LEAGUE CITY, TX77573-5143
 Phone: 832-505-1800
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Trauma Surgery

2086S0127X 02 Physician/General Surgery
 

Surgery

208600000X 02 Physician/General Surgery
 

Surgical Oncology

2086X0206X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for PATRICK J WALLACE · (Male)

NPI # 1740219369
Status Active
Credentials MD
Entity Individual
Enumeration date 07/03/2006
Last updated 11/21/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • TX License # J7243
  • TX Medicaid 041937602
  • Other P00229401 MEDICARE RAILROAD
  • TX Other 8S4802 BLUE CROSS/BLUE SHIELD
Hospital affiliation(s)
  • ST JOSEPH MEDICAL CENTER - (Acute Care)
    1401 ST. JOSEPH PARKWAY
    HOUSTON, TX 77002
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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