DR. Maxwell Wallace, M.D. 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. Maxwell Wallace, M.D. NPI is 1588195267. 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:
1465 S GRAND BLVD
RM 2717
SAINT LOUIS, MO
ZIP 63104-003
Phone: (314) 577-5634
Fax: (314) 577-5616
The NPI 1588195267 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 3/23/2017 and was last updated on 3/23/2017.