Wallace, Robert C

Wallace, Robert C is an individual health care provider with primary practice located at 350 W Thomas Rd , Phoenix AZ 85013-4409. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neuroradiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Neuroradiology is his primary health care specialty. Wallace, Robert C can be contacted via phone (602) 406-3000.

Contact Information

Primary practice address
350 W Thomas Rd Phoenix AZ 85013-4409
Phone: (602) 406-3000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuroradiology 2085N0700X 22535 Arizona
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 22535 Arizona

Profile Details

NPI number 1386619831
LBN Legal business name Wallace, Robert C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Nov 30th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386619831 NPPES
Arizona Other AZ0835370 BCBSAZ
Arizona Other XPY191790 BCBSAZ
Arizona Other 1Z7046 BCBSAZ
Arizona MEDICAID 404369 BCBSAZ

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