Healthcare Provider Details

I. General information

NPI: 1962070466
Provider Name (Legal Business Name): DOYLE ROBERT WALLACE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 HARCOURT RD
INDIANAPOLIS IN
46260-2046
US

IV. Provider business mailing address

8450 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-9105
  • Fax: 317-808-8802
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01098545A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: