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Individual
DR. ROBERT JENNINGS WALLACE
Active
Individual
DR. ROBERT JENNINGS WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME42522
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000121140
UNITED INSURANCE
—
01
—
0007618489
AETNA
—
01
—
05595987
CLEAR
—
01
—
1108108
STAYWELL
FL
05
—
111163300
—
FL
01
—
11382461
CAQH
FL
01
—
14NU6
BLUE CROSS BLUE SHIELD
FL
01
—
14NU6
FLORIDA BLUE
—
01
—
189052
CIGNA
—
Enumeration date
03/10/2011
Last updated
07/24/2025
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