DR. DOUGLAS CHARLES WALLACE (NPI# 1851470033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851470033 |
| Entity Type | Individual |
| Full Name | DR. DOUGLAS CHARLES WALLACE |
| Credential | M.D. |
| Practice Address |
3900 St Francis Way Ste 201 Lafayette IN 47905-4923 |
| Practice Telephone | 7654467981 |
| Practice Fax Number | 7654467982 |
| Mailing Telephone | 7654467981 |
| Mailing Fax Number | 7654467982 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-12-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 01071946A | IN | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 036-101410 | IL | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | G66727 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036112410 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376698753 | Douglas W. Wallace | Oral & Maxillofacial Surgery | 5188 Winton Rd, Fairfield, OH 45014-2900 | 2007-01-24 |
| 1063451144 | Douglas C Wallace | Family Medicine | 3154 Park St, Grove City, OH 43123-3222 | 2006-06-05 |
| 1730794041 | Douglas Wallace | Hearing Instrument Specialist | 95 Post Office Park, Wilbraham, MA 01095-1248 | 2020-09-14 |
| 1285098806 | Douglas Wallace | Emergency Medicine | 625 19th St S, Birmingham, AL 35233 | 2016-04-09 |
| 1811181498 | Douglas Cecil Wallace | Medical Genetics, Ph.D. Medical Genetics | 2014 Hewitt Hall, University of California Irvine, Irvine, CA 92697-3940 | 2007-08-28 |
| 1013058932 | Douglas Mckay Wallace | Psychiatry & Neurology | 1201 Nw 16th St, Miami Va Medical Center, Dept of Neurology, Miami, FL 33125-1624 | 2007-02-12 |
| 1881657989 | Douglas M Wallace | Emergency Medicine | 101 E Wood St, Spartanburg, SC 29303-3040 | 2006-04-10 |
| 1083608053 | Douglas W Wallace | Radiology | 2300 Manchester Expy, Ste A001, Columbus, GA 31904-6802 | 2005-09-07 |
| Street Address |
3900 ST FRANCIS WAY STE 201 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905-4923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245248632 | Barry Joel Karas | Internal Medicine | 3900 St Francis Way, Suite 200, Lafayette, IN 47905-4923 | 2006-08-03 |
| 1568779437 | Jill N. Linder | Nurse Practitioner | 3900 St Francis Way, Suite 200, Lafayette, IN 47905-4923 | 2010-09-13 |
| 1770650517 | David Lin | Internal Medicine | 3900 St Francis Way, Suite 200, Lafayette, IN 47905-4923 | 2006-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174732846 | Mohamad Allam | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 155 Hospital Dr #301, Lafayette, LA 70503-2846 | 2007-05-21 |
| 1942220280 | Richard M Dearman | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5000 Ambassador Caffery, Province Bldg. 14-a, Lafayette, LA 70508 | 2006-07-20 |
| 1477534402 | Thomas X Aufiero | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1176 N. 16th Street, Lafayette, IN 47904 | 2005-11-08 |
| 1174519466 | Michael Jay Scott Sheridan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1116 N 16th St Ste A, Lafayette, IN 47904 | 2005-09-22 |
| 1922005768 | Mitchell David Lirtzman | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2730 Ambassador Caffery Pkwy, Lafayette, LA 70506-5904 | 2005-07-07 |
| 1689825499 | Louisiana Cardiovascular and Limb Salvage Center, Apmc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4811 Ambassador Caffery Parkway, Suite 401a, Lafayette, LA 70508 | 2008-10-10 |
| 1184643512 | John J Schier | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3900 St Francis Way Ste 200, Lafayette, IN 47905-4940 | 2006-07-18 |
| 1770542441 | Kenneth Samuel Stone | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1116 N 16th St, Suite A, Lafayette, IN 47904-2119 | 2006-03-21 |
| 1760489728 | David E Allie | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4811 Ambassador Caffery Parkway, Suite 401a, Lafayette, LA 70508 | 2005-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063900249 | Patrick Finnan Vining | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 545 Barnhill Dr Emerson Hall 215, Indianapolis, IN 46202 | 2018-04-24 |
| 1588084685 | Ashish Pulikal | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7120 Clearvista Dr Ste 5300, Indianapolis, IN 46256-5300 | 2014-04-16 |
| 1649602236 | John F Ansbro | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6199 River Bluff Dr, Newburgh, IN 47630-8850 | 2013-08-06 |
| 1972895266 | Union Hospital, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 351 Maiden Lane, Union Hospital, Inc., Terre Haute, IN 47804-4073 | 2011-05-05 |
| 1013219435 | Walter William Jolly | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10101 Ditch Rd, Carmel, IN 46032-8897 | 2010-11-18 |
| 1407085228 | Alan Thomas Marty | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 214 W Water St, Newburgh, IN 47630-1159 | 2009-07-14 |
| 1336381680 | Giorgio Zanotti | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10590 N Meridian St # 105, Indianapolis, IN 46290-1028 | 2009-04-01 |
| 1639337769 | Kyle W Yancey | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1100 Reid Pkwy Ste 240, Richmond, IN 47374-1157 | 2008-05-27 |
| 1316104839 | Jay B Patel | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 610 N Michigan St Ste 306, South Bend, IN 46601-1079 | 2008-05-21 |
| 1114122488 | Hannah Copeland | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 7910 W Jefferson Blvd Ste 102, Fort Wayne, IN 46804-4159 | 2007-06-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.