Richard B Wallace, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

014847 Issued in LA

Practice address

1504 Spring Hill Ave
Mobile, AL 36604-3207

Phone

(251) 219-3900

NPI assigned

Jul 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306861851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 GENERAL CANBY DR",
            "city": "SPANISH FORT",
            "state": "AL",
            "postal_code": "365278005",
            "telephone_number": "251-625-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 SPRING HILL AVE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366043207",
            "telephone_number": "251-219-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RICHARD",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "014847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Anne Walker
• Debra Walks, M.D.
• Hannah Wallace, DNP, CRNA
• Jonathan O Wallace, CRNA
• Milton Andrew Wallace Jr., MD
• Tracee Wallace
• Amy Waller, PHARMD
• Christal Alantha Waller, APN
• Lindy H Waller, CRNP
• Clinton Barrett Wallis, O.T.

• Family Medicine Physician in Mobile, AL
• Providers in Mobile, AL by specialty
• Family Medicine Physician in Alabama

• 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.