DR. LAURA WALLACE (NPI# 1407119779) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407119779 |
| Entity Type | Individual |
| Full Name | DR. LAURA WALLACE |
| Credential | MD |
| Practice Address |
400 S Kingshighway Blvd Saint Louis MO 63110-1014 |
| Mailing Address |
660 S Euclid Ave C B 8072 Saint Louis MO 63110-1010 |
| Practice Telephone | 3143629123 |
| Practice Fax Number | 3147473338 |
| Mailing Telephone | 3143629123 |
| Mailing Fax Number | 3147473338 |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2018-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 2014041289 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1407119779 | 05 | |
| IL | ENROLLED | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932721701 | Laura Wallace | Behavioral Analyst | 925 Roxburgh Ave, Rock Hill, SC 29732-5505 | 2020-05-14 |
| 1841859576 | Laura A Wallace | Technician | 242 37th St Se Apt 11, Washington, DC 20019-3161 | 2019-06-06 |
| 1679047005 | Laura J Wallace | Advanced Practice Midwife | 115 Eagle Spring Dr Ste A200, Stockbridge, GA 30281-6486 | 2019-01-18 |
| 1699271080 | Laura L Wallace | Licensed Practical Nurse | 2518 Portage Grove Ct, Wooster, OH 44691-1975 | 2018-04-04 |
| 1003140062 | Laura L Wallace | Registered Nurse | 3425 Sw Kimstin Cir, Blue Springs, MO 64015-4579 | 2009-09-23 |
| 1659515013 | Laura Beth Wallace | Marriage & Family Therapist | 3430 Sw 320th St Ste D2, Federal Way, WA 98023-2292 | 2009-04-28 |
| 1417566910 | Laura Anne Wallace | Case Manager/Care Coordinator | 920 W Broadway St, Hobbs, NM 88240-5529 | 2020-07-30 |
| 1841619848 | Laura Jean Wallace | Pediatrics | 8600 Nicollet Ave S, Bloomington, MN 55420-2824 | 2014-04-08 |
| 1457698920 | Laura Ann Wallace | Physical Therapist | 2900 Hawkins Dr, Searcy, AR 72143-4802 | 2013-01-03 |
| 1265737753 | Laura Ann Wallace | Nurse Practitioner | 1445 Us Highway 51 Byp E, Dyersburg, TN 38024-2127 | 2011-01-14 |
| Street Address |
400 S KINGSHIGHWAY BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063407963 | Joseph H Gatewood | Emergency Medicine | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2005-09-16 |
| 1912524117 | Andrew Lamp | Emergency Medicine | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2020-07-03 |
| 1013565308 | Kelley Dufour | Physician Assistant | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-08-29 |
| 1851945869 | Hannah Margaret Pfeifer | Nurse Practitioner | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-07-29 |
| 1922669167 | Nicholas William Karlow | Emergency Medicine | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-06-27 |
| 1487113999 | Sarah Marie Halliday | Nurse Practitioner | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-03-14 |
| 1750849873 | Allison Claire French | Physician Assistant | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-03-07 |
| 1124584651 | Evelyn Kay Scrivner | Nurse Practitioner | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-02-20 |
| 1578027918 | Richard Austin Hazlett | Physician Assistant | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2019-01-30 |
| 1720579063 | Darcey Alana Elliott | Physician Assistant | 400 S Kingshighway Blvd, Saint Louis, MO 63110-1014 | 2018-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649628454 | Sphere Medical Group | Emergency Medicine | 916 Olive St Fl 4, Saint Louis, MO 63101-1459 | 2016-06-02 |
| 1922448000 | Scott Birdwell | Emergency Medicine | 1st Floor Em Administration, Saint Louis University Hospital 3635 Vista, Saint Louis, MO 63110 | 2013-07-03 |
| 1174963052 | John Blakeney Morrison | Emergency Medicine | 4946 Buckingham Ct, Apt 2w, Saint Louis, MO 63108-1430 | 2013-06-25 |
| 1598109001 | Total Access Urgent Care, PC | Emergency Medicine | 12616 Lamplighter Square Shpg Ctr, Saint Louis, MO 63128-2746 | 2013-04-26 |
| 1003179151 | Sean Oliver Cavanaugh | Emergency Medicine | 660 S Euclid Ave # 8072, Washington University Emergency Medicine, Saint Louis, MO 63110-1010 | 2012-06-22 |
| 1730476573 | Yonitte Kinsella | Emergency Medicine | 660 S. Euclid Ave., Campus Box 8072, Saint Louis, MO 63110 | 2011-06-30 |
| 1023304524 | Mary Samantha Jones | Emergency Medicine | 5733 Mcpherson Ave, Saint Louis, MO 63112-1620 | 2011-06-22 |
| 1851527469 | Kimberly Ann Hess | Emergency Medicine | 621 S New Ballas Rd Ste 1001, Tower B, Saint Louis, MO 63141-8264 | 2009-06-09 |
| 1710130919 | Lee Hunter Young | Emergency Medicine | 5168 Amberglow Dr, Saint Louis, MO 63129-3204 | 2008-10-31 |
| 1306019914 | Stephan Brenner | Emergency Medicine | 4628 Mcpherson Ave, Saint Louis, MO 63108-1937 | 2008-04-04 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.