Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles Alan Wallace, MD

Individual provider Plastic and Reconstructive Surgery Physician · NPI 1164422481

Charles Alan Wallace, MD is a Plastic and Reconstructive Surgery in Dallas, Texas. Graduated from University of Texas Southwestern Medical School at Dallas in 1982, 44 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
44
Trained at
University of Texas Southwestern Medical School at Dallas
Licensed in
TX
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

17110 Dallas Pkwy Ste 100
Dallas, TX 75248-1167
Phone: (972) 380-7090
Fax: (972) 380-7016
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence G3885 (TX)

Record details

NPI number1164422481
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 28, 2005
Last updated in NPPESJuly 14, 2010
Mailing address17110 Dallas Pkwy, Suite 100, Dallas, TX 75248-1167

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Medical schoolUNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Graduated 1982 (44 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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