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

Tracy Wallace, MD

Individual provider Pediatrics Physician · NPI 1720306558

Tracy Wallace, MD is a Pediatrics Physician in Gonzales, Louisiana. Licensed in Louisiana. Registered with an NPI since 2010.

Licensed in
LA
In the registry since
2010
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

1937 S Burnside Ave
Gonzales, LA 70737-4632
Phone: (225) 765-5500
Fax: (225) 644-9286
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 204717 (LA)

Record details

NPI number1720306558
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 4, 2010
Last updated in NPPESMay 19, 2021
Certification dateMay 19, 2021
Mailing address5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038

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