Provider Demographics
NPI:1982621520
Name:VU-WALLACE, ANNA HA-LINH PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA HA-LINH
Middle Name:PHUONG
Last Name:VU-WALLACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13442
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78711-3442
Mailing Address - Country:US
Mailing Address - Phone:512-323-5465
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDICAL PKWY
Practice Address - Street 2:#210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3735
Practice Address - Country:US
Practice Address - Phone:512-323-5362
Practice Address - Fax:512-335-7168
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3173207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146764901Medicaid
TX1467649-01Medicaid
TX1467649-01Medicaid
TXG67567Medicare UPIN
TX146764901Medicaid