Dr. Robert D Wallace
Plastic and Reconstructive Surgery
1068 Cresthaven Rd Ste 500
Memphis
, Tennessee 38119
Dr. Robert D Wallace
Plastic and Reconstructive Surgery
1068 Cresthaven Rd Ste 500
Memphis
, Tennessee 38119
(901) 866-8622
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Dr. Robert D Wallace
- 1407 Union Ave Ste 700
- Memphis, TN
- Zip : 38104-3641
- Phone : (901) 866-8622
Second Address
- Dr. Robert D Wallace
- 1068 Cresthaven Rd Ste 500
- Memphis, TN
- Zip : 38119
- Phone : (901) 866-8525
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | 27658 | TN |
National Provider Identifier
| NPI | 1023075637 |
|---|---|
| Provider Name | Dr. Robert D Wallace |
| First Address | Memphis, TN 38104-3641 |
| Second Address | Memphis, TN 38119 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/04/2006 |
| Last Update Date | 01/02/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00118676 | (05) | MS |
| 130322001 | (05) | AR |
| 3804973 | (05) | TN |
| G00069 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.