Andrew Blake Wallace, M.D.

Diagnostic Radiology Physician · Saint Louis, MO

Individual Active NPI

NPI number 1740626654

Practice location

510 S Kingshighway Blvd
Mallinckrodt Institue of Radiology
Saint Louis, MO 63110-1016

Phone: (314) 362-2978

Open in Google Maps

NPI record

NPI: 1740626654
Entity type: Individual (Type 1)
Enumeration date: May 18, 2013
Last updated: May 5, 2021
Certified: May 5, 2021
Sole proprietor: No

Specialties & taxonomy codes

Taxonomy	Code	License	State
Diagnostic Radiology Physician Primary	`2085R0202X`	2020-04583	NC
Diagnostic Radiology Physician	`2085R0202X`	2014013932	MO

Mailing address

1025 Medical Center Dr
Wilmington, NC 28401-7354

Phone: (910) 762-3882

About Dr. Wallace

Andrew Blake Wallace, M.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Diagnostic Radiology Physician (code 2085R0202X). The practice location is 510 S Kingshighway Blvd, Mallinckrodt Institue of Radiology, Saint Louis, MO 63110-1016. The NPI number 1740626654 was assigned on May 18, 2013 and the record was last updated on May 5, 2021.

Dr. Wallace lists 2 licenses in the registry: #2020-04583 (NC) for Diagnostic Radiology Physician; #2014013932 (MO) for Diagnostic Radiology Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Andrew Blake Wallace, M.D.?

The NPI number is 1740626654.

What is the phone number of Dr. Wallace?

The phone number listed for the practice location is (314) 362-2978.

Where is Dr. Wallace located?

510 S Kingshighway Blvd, Mallinckrodt Institue of Radiology, Saint Louis, MO 63110-1016.

What is the taxonomy code for Dr. Wallace?

The primary taxonomy code is 2085R0202X – Diagnostic Radiology Physician; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

Other Diagnostic Radiology Physician providers in Saint Louis

Aman Patel1201 S Grand Blvd
Hilton I. Price, MD11133 Dunn Rd
Kyle Anthony O'Blanc, MD1825 High Oak Rd
Michael D. Bazzani, M.D.10010 Kennerly Rd
Adrian Alberto Sanchez, MD510 S Kingshighway Blvd
Ziad Walid Tarcha, MD510 S Kingshighway Blvd
James Edward Kelly, MD510 S Kingshighway Blvd
Cindy Xin Zhang, M.D.615 S New Ballas Rd
Joshua S. Shimony, MD510 S Kingshighway Blvd
Pornchai Moolsintong, M.D.6420 Clayton Rd
Rashid Fuad Al-Sukaiti, MD510 S Kingshighway Blvd
Monica R. Drylewicz, MD10010 Kennerly Rd

All Diagnostic Radiology Physician providers in Saint Louis, MO →