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

Timothy R Wallace, DO

Individual provider Family Medicine Physician · NPI 1275725384

Timothy R Wallace, DO is a Family Practice in Oshkosh, Wisconsin. Qualified in 2004, 22 years ago. Practices with Aamg Reach PLLC, a 53-clinician group. Licensed in Pennsylvania, South Carolina and Wisconsin.

Years since qualifying
22
Licensed in
PA, SC, WI
In the registry since
2007
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

855 N Westhaven Dr
Oshkosh, WI 54904-7668
Phone: (920) 303-8700
Fax: (920) 303-8832
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 60032 (WI)
Family Medicine Physician Taxonomy 207Q00000X · Licence OS013436 (PA)
Family Medicine Physician Taxonomy 207Q00000X · Licence 1195 (SC)

Record details

NPI number1275725384
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedAugust 13, 2007
Last updated in NPPESApril 9, 2025
Certification dateApril 9, 2025
Mailing addressPo Box 735044, Chicago, IL 60673-5044

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Aamg Reach Pllc — 53 clinicians
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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