EMMETT LEE WALLACE DO
NPI 1215992334
Family Medicine in Bettendorf, IA

Q: What is Emmett Wallace's NPI number?

The NPI number for Emmett Wallace is 1215992334. It was assigned to this individual provider in the NPPES registry on April 20, 2006.

Q: What is Emmett Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Emmett Wallace was last updated on July 22, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 20, 2006

1019 BROADLAWN AVENUE, BETTENDORF, IA 52722(563) 359-1181(563) 386-3177 Get Directions Write a Review

NPPES record last updated: July 22, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Emmett Lee Wallace Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EMMETT LEE WALLACE DO (NPI 1215992334) is an individual family medicine provider in Bettendorf, Iowa, licensed in Iowa (01133) and active in the NPI registry since April 2006.

NPPES Registry Identity

NPI1215992334

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameEMMETT LEE WALLACECredential: DO

Location Address1019 BROADLAWN AVENUEBettendorf, IA 52722

Mailing Address1019 Broadlawn AvenueBettendorf, IA 52722 · (563) 359-1181 · Fax (563) 386-3177

Phone(563) 359-1181

Fax(563) 386-3177

Sole ProprietorYes

Enumeration DateApril 20, 2006

Last NPPES UpdateJuly 22, 2011

✔ NPI 1215992334 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in IA · 01133✔ Licensed in MO · 27754✔ Licensed in IL · 03652892

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1019 BROADLAWN AVENUE, Bettendorf, IA 52722

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Other Identifiers 4

Medicare ID-Type Unspecified0158642IA

Medicaid0047902IA

Medicare UPIND46482IA

Other0158642Bcbs

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Emmett Wallace's NPI number?

The NPI number for Emmett Wallace is 1215992334. It was assigned to this individual provider in the NPPES registry on April 20, 2006.

Where is Emmett Wallace located?

Emmett Wallace practices at 1019 Broadlawn Avenue, Bettendorf, IA 52722. The listed phone number is (563) 359-1181.

What is Emmett Wallace's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Emmett Wallace was last updated on July 22, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.