Dr. Wallace Lyle Past , MD
General Practice • Crestwood, KY
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Wallace Past has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Wallace Past, MD was a registered General Practice practicing in Crestwood, KY. Throughout an active medical career spanning 1 years, Dr. Past provided care at the practice location at 4608 HERITAGE MANOR until profile deactivation on 2012-03-08.
Practice Location & Contact Primary Location
4608 Heritage Manor
Crestwood, KY 40014
Specialty Benchmarks & Practice Insights
Comparative analytics for General Practice in Crestwood, KY
Practicing in Crestwood, KY (142 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 208D00000X
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on March 08, 2012
NPI status registered as active in NPPES database
Registered at 4608 HERITAGE MANOR, CRESTWOOD, KY 40014 (Tel: 5026146688)
Registered at 4608 HERITAGE MANOR, CRESTWOOD, KY 40014 (Tel: 5026146688)
Recorded as WALLACE PAST, M.D.
General Practice (License #01018231A in IN)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
4608 Heritage Manor
Crestwood, KY 40014
Phone: 5026146688
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