Robert Duncan Wallace, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

65-148121 Issued in UT

Practice address

2972 Devonshire Cir
Salt Lake City, UT 84108-2526

Phone

(801) 486-7940

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. R Duncan Wallace Other name

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• R. Duncan Wallace, M.D., P.C.

  • Psychiatry Physician
  • Salt Lake City, UT
  • NPI 1700120334
  Medicare reassignment NPD
• St Mark's Professional Services, LLC

  • Internal Medicine Physician
  • Salt Lake City, UT
  • NPI 1912925629
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1134133200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2972 DEVONSHIRE CIR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082526",
            "telephone_number": "801-486-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2972 DEVONSHIRE CIR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082526",
            "telephone_number": "801-486-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "DUNCAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "65-148121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "R",
            "last_name": "WALLACE",
            "middle_name": "DUNCAN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Justice Kassidy Wallace
• Laney Wallace
• Mark Spangler Wallace, DDS
• Marshall W. Wallace, MD
• Rebecca Wallace, APRN
• Sara Elizabeth Wallace, DPT
• Rachel Jo Wallenda
• Brynn Wallentine
• Brenda Lee Waller
• Eliza Denise Waller

• Psychiatry Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychiatry Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.