Wallace, Maxwell

Wallace, Maxwell is an individual health care provider with primary practice located at 1465 S Grand Blvd Rm 2717, Saint Louis MO 63104-1003. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, which is considered as his primary health care specialty. Wallace, Maxwell can be contacted via phone (314) 577-5634.

Contact Information

Primary practice address
1465 S Grand Blvd Rm 2717 Saint Louis MO 63104-1003
Phone: (314) 577-5634
Fax: (314) 577-5616
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 2022027207 Missouri

Profile Details

NPI number 1588195267
LBN Legal business name Wallace, Maxwell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2017
Last updated Aug 22nd, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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