Individual
WILLIAM ROBERT WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4000
(859) 258-6203
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4000
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
55629
KY
207R00000X
Internal Medicine Physician
2016015671
MO
Other
Enumeration date
06/11/2016
Last updated
03/29/2023
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