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

Dr. Maxwell Wallace, MD

Individual provider Neurology with Special Qualifications in Child Neurology Physician · NPI 1588195267

Dr. Maxwell Wallace, MD is a Neurology with Special Qualifications in Child Neurology Physician in Saint Louis, Missouri. Licensed in Missouri. Registered with an NPI since 2017.

Licensed in
MO
In the registry since
2017
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

1465 S Grand Blvd Rm 2717
Saint Louis, MO 63104-1003
Phone: (314) 577-5634
Fax: (314) 577-5616
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurology with Special Qualifications in Child Neurology Physician (primary) Taxonomy 2084N0402X · Licence 2022027207 (MO)

Record details

NPI number1588195267
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 23, 2017
Last updated in NPPESAugust 22, 2022
Certification dateAugust 22, 2022

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