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

William Robert Wallace, MD

Individual provider Internal Medicine Physician · NPI 1851740609

William Robert Wallace, MD is an Emergency Medicine in Lexington, Kentucky. Qualified in 2016, 10 years ago. Practices with Southeastern Emergency Physicians LLC, a 786-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kentucky and Missouri.

Years since qualifying
10
Licensed in
KY, MO
In the registry since
2016
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

1221 S Broadway
Lexington, KY 40504-2701
Phone: (859) 258-4000
Fax: (859) 258-6203
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 20828 W Deer Ridge Dr, Warrenton, MO 63383-6548 — (731) 693-1601

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 55629 (KY)
Internal Medicine Physician Taxonomy 207R00000X · Licence 2016015671 (MO)

Record details

NPI number1851740609
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 11, 2016
Last updated in NPPESMarch 29, 2023
Certification dateMarch 29, 2023
Mailing address1221 S Broadway, Lexington, KY 40504-2701

Medicare enrollment

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

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Southeastern Emergency Physicians Llc — 786 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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