Active NPI
Robert Jay Wallace, M.D.
- Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
- Bakersfield, CA
National Provider Identifier
1649484635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
- License
- G042135
- Practice address
- 6250 Alfred Harrell Hwy
Bakersfield, CA 93308-9654 - Phone
- (661) 203-9454
- Fax
- (661) 322-7675
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician | 207VH0002X | G042135 | CA | Primary |
Addresses
Primary practice location
6250 Alfred Harrell Hwy
Bakersfield, CA 93308-9654
Mailing address
6250 Alfred Harrell Hwy
Bakersfield, CA 93308-9654
Phone (661) 203-9454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G042135 | CA | MD | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649484635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6250 ALFRED HARRELL HWY",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933089654",
"telephone_number": "661-203-9454",
"fax_number": "661-322-7675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6250 ALFRED HARRELL HWY",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933089654",
"telephone_number": "661-203-9454",
"fax_number": "661-322-7675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ROBERT",
"middle_name": "JAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VH0002X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Hospice and Palliative Medicine",
"state": "CA",
"license": "G042135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.