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Search › Missouri › 2084N0402X

Maxwell Wallace, M.D

NPI 1588195267 · on the registry since 2017

Practice

Address
1465 S Grand Blvd
Rm 2717
Saint Louis, MO 63104
Phone
(314) 577-5634
Fax
(314) 577-5616
Organisation at this address
Lifenet, Inc.
St Louis University
St Louis University
St Louis University
St Louis University
Inferred from a shared address, not stated in the registry.
Clinicians at this address
531

Registry record

Primary taxonomy
2084N0402X
2084N0402X
Licence states on file
MO
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2022-08-22

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