DAVID R. WALLACE, JR. M.D. – NPI #1265743595
Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Health Care Provider Taxonomy Code for Radiology

DAVID WALLACE, JR. is a radiologist located in LAKE CHARLES, LA. NPPES has assigned the NPI number 1265743595 to DAVID WALLACE, JR. on July 01, 2010. It is a Type-1 NPI, indicating this NPI number is associated with an individual. According to the NPI data, there are 3 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 2085R0202X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Diagnostic Radiology

The NPI profile was last updated on Mar 12, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DAVID WALLACE, JR. below.

NPI Profile for
DAVID R. WALLACE, JR.

NPI Number
1265743595
Enumeration Date

(about 16 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
DAVID R. WALLACE, JR.
Credentials
M.D.
Primary location
1800 RYAN ST STE 105
LAKE CHARLES, LA 70601-6078
Phone: (337) 439-4706 Fax: (337) 439-8110
3 Other location(s):
10310 The Grove Blvd
Baton Rouge, LA 70836-6455
Phone: (225) 761-5200
Fax: (225) 761-5750
1453 E Bert Kouns Industrial Loop Ste 210
Shreveport, LA 71105-6810
Phone: (318) 798-4623
1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105-5634
Phone: (318) 798-4500
Mailing address
Same as primary location
Sole Proprietor
No
Updated
Certification Date
Mar 12, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085R0202X
- Radiology / Diagnostic Radiology (Primary)		 CA A136122
390200000X
- Student in an Organized Health Care Education/Training Program

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Education
LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT - Graduated 2010
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
DAVID WALLACE, JR. is affiliated with the following medical group(s):
  • HOSPITAL
    • CHRISTUS OCHSNER ST PATRICK HOSPITAL
      524 DR MICHAEL DEBAKEY DRIVE
      LAKE CHARLES, LA 70601
    • LAKE CHARLES MEMORIAL HOSPITAL
      1701 OAK PARK BLVD
      LAKE CHARLES, LA 70601
    • OCHSNER MEDICAL CENTER - BATON ROUGE
      17000 MEDICAL CENTER DR
      BATON ROUGE, LA 70816
    • SPECIALISTS HOSPITAL SHREVEPORT
      1500 LINE AVENUE
      SHREVEPORT, LA 71101
    • WEST CALCASIEU CAMERON HOSPITAL
      701 EAST CYPRESS STREET
      SULPHUR, LA 70663

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