Wallace Urology Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

015359 Issued in TN

Legal business name

WALLACE UROLOGY INC

Practice address

1325 Eastmoreland Ave Ste 425
Memphis, TN 38104-7541

Phone

(901) 272-3200

Fax

(901) 278-3441

NPI assigned

Sep 28, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Charles Russell Wallace Jr., M.D.

Title

Medical Doctor

Phone

(901) 272-3200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1316496664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE STE 425",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047541",
            "telephone_number": "901-272-3200",
            "fax_number": "901-278-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE STE 425",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047541",
            "telephone_number": "901-272-3200",
            "fax_number": "901-278-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE UROLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "901-272-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "TN",
            "license": "015359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Louise Walker, D.O.
• Willie Walker
• Zina Walker
• Barry M Wall, MD
• Wallace Plastic Surgery Group, PLLC
• Carrie Wallace
• David Alexander Wallace
• Jacquel Wallace, PHARMD
• James John Wallace, DO
• Jennifer F. Wallace, NP

• Urology Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Urology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.