DR. ROBERT D WALLACE (NPI# 1023075637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023075637 |
| Entity Type | Individual |
| Full Name | DR. ROBERT D WALLACE |
| Credential | MD |
| Practice Address |
1068 Cresthaven Rd Ste 500 Memphis TN 38119 |
| Mailing Address |
1407 Union Ave Ste 700 Memphis TN 38104-3641 |
| Practice Telephone | 9018668525 |
| Mailing Telephone | 9018668622 |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2019-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
27658 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 130322001 | 05 | |
| TN | 3804973 | 05 | |
| MS | 00118676 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1910 Nonconnah Blvd, Suite 120, Memphis, TN 381322113 | 9014482300 | 9014486657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316430176 | Robert E Wallace | Case Manager/Care Coordinator | 283 Old Colliers Way, Weirton, WV 26062-4073 | 2018-06-07 |
| 1801337134 | Robert William Wallace II | Student in an Organized Health Care Education/Training Program | 204 N Silver Maple Dr, Slidell, LA 70458-5483 | 2017-03-20 |
| 1780015610 | Robert G. Wallace | Radiology | 1130 Goat Rock Road, Fortson, GA 31808 | 2013-12-03 |
| 1972947257 | Robert William Wallace | Registered Nurse | 40 Ridge Dr, West Hurley, NY 12491-5627 | 2013-04-17 |
| 1487991683 | Robert J Wallace | Acupuncturist | 1619 W Montrose, Chicago Holistic Medicine, Chicago, IL 60613 | 2013-01-08 |
| 1154582773 | Robert Lee Wallace | Counselor | 110 S Hancock St, Rockingham, NC 28379-3675 | 2008-06-17 |
| 1649484635 | Robert Jay Wallace | Obstetrics & Gynecology | 6250 Alfred Harrell Hwy, Bakersfield, CA 93308-9654 | 2007-05-09 |
| 1023132644 | Robert S Wallace | Chiropractor | 7 Centre Dr, Suite 10, Monroe, NJ 08831-1565 | 2007-03-19 |
| 1750443024 | Robert Wallace | Pharmacist | 12421 W Denton Ave, Litchfield Park, AZ 85340-3435 | 2006-12-14 |
| 1922113174 | Robert Vernon Wallace | Family Medicine | 400 Lee Blvd, Lehigh Acres, FL 33936-4923 | 2006-08-20 |
| Street Address |
1068 CRESTHAVEN RD STE 500 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760823595 | Kalyan Chakravarthy Dadireddy | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2013-07-09 |
| 1851659981 | Haiqiao Jiao | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2012-04-26 |
| 1801185228 | Cedric Lawon Hunter | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2011-04-06 |
| 1962631341 | Sai Ramakrishna Velamuri Venkata | Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2009-07-07 |
| 1952543084 | Sonia Alvarez | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2009-04-06 |
| 1487611000 | Edward A Luce | Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119 | 2006-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469628 | Jojuan Fullwiley | Behavioral Analyst | 6685 Quince Rd Ste 116, Memphis, TN 38119 | 2017-10-27 |
| 1336675297 | Jill Budynas Depriest | Counselor | 5583 Murray Ave Ste 203, Memphis, TN 38119 | 2017-05-11 |
| 1396279220 | Glen Matthew Stamps Jr. | Counselor | 5583 Murray Ave Ste 207, Memphis, TN 38119 | 2017-04-18 |
| 1598117442 | Hazel Aberdeen | Chiropractor | 1911 Memphis Tennessee, Memphis, TN 38119 | 2016-07-04 |
| 1831569060 | E-c-t Non Emergency Medical Transport | Non-emergency Medical Transport (VAN) | 6869 Woodlake Dr, Memphis, TN 38119 | 2015-09-30 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| 1467857664 | Allan Jacob Katz | Counselor | 5668 Rex Rd, Suite 104, Memphis, TN 38119 | 2014-10-30 |
| 1962836015 | Judy Ann Harrick | Acupuncturist | 5575 Poplar Ave., #702, Memphis, TN 38119 | 2013-08-26 |
| 1366791949 | Jennifer Denyes Bidelman | Audiologist | 5625 Poplar Avenue, Memphis, TN 38119 | 2012-08-29 |
| 1578833620 | Elizabeth Mary Dion-douglass | Pharmacist | 2891 Kirby Parkway, Memphis, TN 38119 | 2012-01-06 |
| Find all providers in zip 38119 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851657597 | Jordi Puente Espel | Surgery | 6215 Humphreys Blvd Ste 103, Memphis, TN 38120-2382 | 2012-04-06 |
| 1730475179 | Sarah Elizabeth Hammond | Surgery | Plastic Surgery Group, 80 Humphreys Blvd #100, Memphis, TN 38120 | 2011-06-23 |
| 1699753954 | Clinic of Plastic and Reconstructive Surgery, P.a. | Surgery | 1000 Brookfield Rd, Suite 100, Memphis, TN 38119-0853 | 2006-01-06 |
| 1972166429 | Ammar Obaid Mahmood | Surgery | 910 Madison Ave Ste 447, Memphis, TN 38103-3403 | 2019-04-19 |
| 1316380694 | Meredith Wall Wagner | Surgery | 6254 Poplar Ave, Memphis, TN 38119 | 2013-04-16 |
| 1962631341 | Sai Ramakrishna Velamuri Venkata | Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2009-07-07 |
| 1255366621 | Sherrill Bryce Stewart | Surgery | 6025 Walnut Grove Rd, Suite 612, Memphis, TN 38120-2131 | 2006-07-12 |
| 1487611000 | Edward A Luce | Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119 | 2006-04-27 |
| 1366409104 | Roberto D Lachica | Surgery | 6029 Walnut Grove Rd Ste 210, Memphis, TN 38120-2112 | 2006-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255829552 | Ahmed Al Bayati | Surgery | Medical Center North 1161 21st Avenue S Suite Ccc-4312, Nashville, TN 37232-0001 | 2018-04-23 |
| 1275039661 | Mekia Truclaye Kauffman | Surgery | 1934 Alcoa Hwy Ste D-362, Knoxville, TN 37920-1524 | 2018-04-04 |
| 1497137574 | Daniel A Hatef Md, Pllc | Surgery | 6200 Highway 100 Ste 101, Nashville, TN 37205-4252 | 2015-06-24 |
| 1336588201 | Nashville Plastic and Reconstructive Surgery, Plc | Surgery | 2201 Murphy Ave Ste 301, Nashville, TN 37203-1956 | 2013-06-24 |
| 1942500319 | Sieveking Plastic Surgery | Surgery | 204 23rd Ave N, Nashville, TN 37203-1502 | 2010-11-01 |
| 1275733081 | Natasha Nicole Luckey | Surgery | 2001 Mallory Ln Ste 205, Franklin, TN 37067-8235 | 2007-07-19 |
| 1841406063 | Robert F Garza | Surgery | 4322 Harding Rd, Suite 326, Nashville, TN 37205-2490 | 2007-05-15 |
| 1558583021 | Stewart Charles Little | Surgery | 2358 Lifestyle Way Ste 212, Chattanooga, TN 37421-2291 | 2007-05-03 |
| 1780711804 | Jack Fisher | Surgery | 310 23rd Ave N Ste 101, Nashville, TN 37203-1525 | 2007-02-27 |
| 1497809750 | Francis Xavier Letard Jr. | Surgery | 10265 Kingston Pike, Suite C, Knoxville, TN 37922 | 2007-01-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.