Individual provider · Type 1 NPI

Jacob Henry Wallace, MD

Obstetrics & Gynecology Physician · St. Louis, MO

NPI number 1124604061 Active

Practice location

401 Holly Hills Ave
St. Louis, MO 63111-2410

Call (314) 353-5190 Map

Fax (314) 353-7631

Mailing address

3990 Bowen St
St. Louis, MO 63116-3145

Other practice locations

  • 4352 Manchester Ave, St. Louis, MO 63110-2138 · (314) 531-5444

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Obstetrics & Gynecology Physician Primary 207V00000X2025027770 (MO)

Obstetrics & Gynecology Physician: An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

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About NPI 1124604061

Jacob Henry Wallace, MD's National Provider Identifier is 1124604061, issued on Mar 22, 2021. The primary taxonomy on file is Obstetrics & Gynecology Physician (207V00000X), and the practice location is in St. Louis, MO. The record was last updated on Jul 8, 2025.