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

Dr. Philip C Wallace, MD

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1629258322

Dr. Philip C Wallace, MD is a Sports Medicine in Bend, Oregon. Graduated from Meharry Medical College School of Medicine in 2005, 21 years ago. Practices with Central Oregon Spine and Sports LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Oregon and Texas.

Years since qualifying
21
Trained at
Meharry Medical College School of Medicine
Licensed in
OR, TX
In the registry since
2007
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

2115 NE Wyatt CT 101
Bend, OR 97701-6324
Phone: (541) 323-6280
Fax: (541) 323-6288
Show map & directions

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

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence MD152056 (OR)
Physical Medicine & Rehabilitation Physician Taxonomy 208100000X · Licence P1432 (TX)

Record details

NPI number1629258322
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 9, 2007
Last updated in NPPESMay 10, 2017
Mailing address2115 Ne Wyatt Ct, Suite 101, Bend, OR 97701-7678

Medicare enrollment

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

Medicare specialtySPORTS MEDICINE
Medical schoolMEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE
Graduated 2005 (21 years in practice)
Group practice Central Oregon Spine And Sports Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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