Wallace Plastic Surgery Group, PLLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

WALLACE PLASTIC SURGERY GROUP, PLLC

Practice address

1000 Brookfield Rd Ste 100
Memphis, TN 38119-0853

Phone

(901) 779-6538

NPI assigned

Aug 16, 2022

Last updated

Aug 16, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert D Wallace, MDNPI 1023075637

Title

Owner

Phone

(901) 779-6538

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert D Wallace, MD

  • Plastic and Reconstructive Surgery Physician
  • Memphis, TN
  • NPI 1023075637
  Medicare reassignment NPD Authorized official
• Sai Ramakrishna Velamuri Venkata, M.D

  • Plastic and Reconstructive Surgery Physician
  • Tampa, FL
  • NPI 1962631341

  TN

  Medicare reassignment NPD
• Alexandra Paige Botts, PA-C

  • Physician Assistant
  • Memphis, TN
  • NPI 1235863572
  Medicare reassignment

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1497473557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 TIDES RIDGE CV",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202625",
            "telephone_number": "901-779-6538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BROOKFIELD RD STE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190853",
            "telephone_number": "901-779-6538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE PLASTIC SURGERY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-779-6538",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valencia D Walker
• Victoria Louise Walker, D.O.
• Willie Walker
• Zina Walker
• Barry M Wall, MD
• Wallace Urology Inc
• Carrie Wallace
• David Alexander Wallace
• Jacquel Wallace, PHARMD
• James John Wallace, DO

• Plastic Surgery Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Plastic Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.