Individual
DR. ROBERT D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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