DR. JACOB WALLACE MD NPI 1124604061

NPI Information

DR. Jacob Wallace, MD is a student in an organized health care education training program in Saint Louis, MO. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. DR. Jacob Wallace, MD NPI is 1124604061. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6420 CLAYTON RD
SAINT LOUIS, MO
ZIP 63117-811
Phone: (314) 768-8000

The NPI 1124604061 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/22/2021 and was last updated on 3/22/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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