Individual
DR. ROBERT D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1068 CRESTHAVEN RD STE 500, MEMPHIS, TN 38119
(901) 866-8525
Mailing address
1407 UNION AVE STE 700, MEMPHIS, TN 38104-3641
(901) 866-8622
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
27658
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118676
—
MS
05
—
130322001
—
AR
05
—
3804973
—
TN
Enumeration date
04/27/2006
Last updated
02/01/2019
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