Physician Compare National (NPI:1952599573)

HEALTHCARE PROVIDER: ROBERT A. WALLOCK

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1952599573
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911166004
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120308000740
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WALLOCK
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MARQUETTE UNIVERSITY SCHOOL OF DENTISTRY
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12720 N AVE BUILDING B
	Group Practice or individual's line 1 address
City	BROOKFIELD
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	530054637
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y