Individual
DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 W LINCOLN ST, BELLEVILLE, IL 62220-1900
(618) 233-6044
(618) 233-3287
Mailing address
340 W LINCOLN ST, BELLEVILLE, IL 62220-1900
(618) 233-6044
(618) 233-3287
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036092919
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360929191
—
IL
01
—
060046618
RR MEDICARE
—
01
—
093355
HEALTH ALLIANCE
—
01
—
107076
BCBS MO
MO
01
—
12269
ESSENCE
—
01
—
1734162
UHC
—
05
—
205943608
—
MO
01
—
235649
HEALTHLINK
—
01
—
2501200
SECURE HORIZONS
—
01
—
37099690008
GHP
—
01
—
54656
CMR
—
01
—
E43629
MERCY
—
01
—
P01024928
RAILROAD
IL
Enumeration date
06/29/2006
Last updated
04/17/2017
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