Wallace Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

WALLACE MEDICAL GROUP

Practice address

1986 E Glacier PL
Chandler, AZ 85249-2886

Phone

(520) 245-7379

Fax

(888) 700-8257

NPI assigned

Jan 27, 2014

Organization subpart

No

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

Authorized official

Name

Robert Wallace, BS

Title

Chief Executive Officer

Phone

(520) 245-7379

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1942623939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1986 E GLACIER PL",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852492886",
            "fax_number": "888-700-8257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1986 E GLACIER PL",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852492886",
            "telephone_number": "520-245-7379",
            "fax_number": "888-700-8257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-245-7379",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Coleen Walker, MD
• Renee Martha Walker, FNP-C
• Robert Daniel Walker, DDS, MS
• Robert F Walker Jr., D.D.S.
• Stephanie L Walker, DDS
• Shelby Wallace- Barnaby
• Jacy Shea Wallace
• Khairunissa Wallani
• Joshua Wallbrecht, M.D.
• Desiree Wallin, ED.S

• Specialist in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; 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.