Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Jacob Henry Wallace, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1124604061

Dr. Jacob Henry Wallace, MD is an Obstetrics/Gynecology in Saint Louis, Missouri. Qualified in 2021, 5 years ago. Practices with Family Care Health Centers, a 52-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
5
Licensed in
MO
In the registry since
2021
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

401 Holly Hills Ave
Saint Louis, MO 63111-2410
Phone: (314) 353-5190
Fax: (314) 353-7631
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4352 Manchester Ave, Saint Louis, MO 63110-2138 — (314) 531-5444

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence 2025027770 (MO)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1124604061
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 22, 2021
Last updated in NPPESJuly 8, 2025
Certification dateJuly 8, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Family Care Health Centers — 52 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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