Jonathan O Wallace, CRNA is a medicare enrolled "Anesthesiology" in Mobile, Alabama. His current practice location is
5 Mobile Infirmary Cir, Mobile, Alabama. You can reach out to his office (for appointments etc.) via phone at
(251) 432-4497.
Jonathan O Wallace is licensed to practice in Alabama (license number 1101813) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1609821156.
Provider's Profile
| Full Name | Jonathan O Wallace |
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| Gender | Male |
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| Speciality | |
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| Experience | Years |
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| Location | 5 Mobile Infirmary Cir, Mobile, Alabama |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jonathan O Wallace attended and graduated from in
NPI Data:
- NPI Number: 1609821156
- Provider Enumeration Date: 05/23/2006
- Last Update Date: 09/11/2025
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
Medical Identifiers
Medical identifiers for Jonathan O Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1609821156 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 367500000X | Nurse Anesthetist, Certified Registered | 1101813 (Alabama) | Secondary |
| 207L00000X | Anesthesiology | 1101813 (Alabama) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jonathan O Wallace is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jonathan O Wallace, CRNA
Po Box 934369,
Atlanta, GA 31193-0001
Ph: (800) 897-6169 | Jonathan O Wallace, CRNA
5 Mobile Infirmary Cir,
Mobile, AL 36607-3513
Ph: (251) 432-4497 |
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