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

Dr. David R Wallace Jr., MD

Individual provider Diagnostic Radiology Physician · NPI 1265743595

Dr. David R Wallace Jr., MD is a Diagnostic Radiology in Lake Charles, Louisiana. Graduated from Louisiana State University School of Medicine in Shreveport in 2010, 16 years ago. Practices with Highland Clinic, a Prof Med Corp, a 60-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in California and Louisiana.

Years since qualifying
16
Trained at
Louisiana State University School of Medicine in Shreveport
Licensed in
CA, LA
In the registry since
2010
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1800 Ryan St Ste 105
Lake Charles, LA 70601-6078
Phone: (337) 439-4706
Fax: (337) 439-8110
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 10310 The Grove Blvd, Baton Rouge, LA 70836-6455 — (225) 761-5200
  • 1455 E Bert Kouns Industrial Loop, Shreveport, LA 71105-5634 — (318) 798-4500
  • 1453 E Bert Kouns Industrial Loop Ste 210, Shreveport, LA 71105-6810 — (318) 798-4623

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence MD.204718 (LA)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence A136122 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1265743595
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 1, 2010
Last updated in NPPESMarch 12, 2025
Certification dateMarch 12, 2025

Medicare enrollment

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

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolLOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated 2010 (16 years in practice)
Group practice Highland Clinic, A Prof Med Corp — 60 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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