Wallace, Robert D

Wallace, Robert D is an individual health care provider with primary practice located at 1068 Cresthaven Rd Ste 500 , Memphis TN 38119. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Wallace, Robert D can be contacted via phone (901) 866-8525.

Contact Information

Primary practice address
1068 Cresthaven Rd Ste 500 Memphis TN 38119
Phone: (901) 866-8525
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 27658 Tennessee

Profile Details

NPI number 1023075637
LBN Legal business name Wallace, Robert D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Feb 1st, 2019 - about 7 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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Identifiers

StateTypeNumberIssuer
All States NPI 1023075637 NPPES
Arkansas MEDICAID 130322001
Arkansas MEDICAID 00118676
Arkansas MEDICAID 3804973

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