Organization
WALLACE PLASTIC SURGERY GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D WALLACE MD (OWNER)
(901) 779-6538
Entity
Organization
Contact information
Practice address
1000 BROOKFIELD RD STE 100, MEMPHIS, TN 38119-0853
(901) 779-6538
Mailing address
1065 TIDES RIDGE CV, MEMPHIS, TN 38120-2625
(901) 779-6538
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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