Search › Missouri › 207V00000X
Jacob Wallace, MD
NPI 1124604061 · on the registry since 2021
Practice
- Address
- 401 Holly Hills Ave
Saint Louis, MO 63111 - Phone
- (314) 353-5190
- Fax
- (314) 353-7631
- Organisation at this address
- Family Care Health Centers
Family Care Health Centers PharmacyInferred from a shared address, not stated in the registry. - Clinicians at this address
- 82
Additional practice sites
- 4352 Manchester Ave, Saint Louis, MO
Registry record
- Primary taxonomy
- 207V00000X
207V00000X
- Also registered as
- 390200000X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri