Robert L Wallace, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

20020421 Issued in NM

Practice address

3100 N Tenaya Way
Las Vegas, NV 89128-0436

Phone

(972) 915-3600

Fax

(972) 915-3636

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

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 and National Provider Directory roles.

• Fremont Emergency Services Scherr LTD

  • Emergency Medicine Physician
  • Las Vegas, NV
  • NPI 1679550149
  Medicare reassignment NPD
• Fremont Emergency Services Scherr LTD

  • Emergency Medicine Physician
  • North Las Vegas, NV
  • NPI 1316488141
  NPD
• Fremont Emergency Services Scherr LTD

  • Emergency Medicine Physician
  • Las Vegas, NV
  • NPI 1518120971
  NPD
• Southwest Emergency Services, Inc.

  • Emergency Medicine Physician
  • Las Vegas, NV
  • NPI 1346459104
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280275200000",
    "number": "1588734099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9229 LBJ FWY",
            "address_2": "STE 250",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752433405",
            "telephone_number": "800-346-0747",
            "fax_number": "972-739-2638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 N TENAYA WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280436",
            "telephone_number": "972-915-3600",
            "fax_number": "972-915-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "20020421",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "4114",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NV",
            "license": "4114",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77052",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie L. Wallace, CPC PERMIT #IP150410
• Melanie Rose Williams Wallace, NNP
• Misty Lee Wallace
• Nicolas Wallace
• Nolan Michael Wallace, DO
• Sharon Wallace
• Stacy Rose Wallace
• Sun Me Wallace
• Sunday Shanntel Wallace
• Tamika Wallace

• Emergency Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Emergency Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; 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.