| B Jeffrey Wallis Md Pa | |
|
6152 W Corporate Oaks Dr Crystal River FL 34429-8722 | |
| (352) 564-3900 | |
| (352) 564-3903 |
| Full Name | B Jeffrey Wallis Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 6152 W Corporate Oaks Dr, Crystal River, Florida |
| Authorized Official Name and Position | Barrett Jeffrey Wallis (OWNER) |
| Authorized Official Contact | 3524008000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| B Jeffrey Wallis Md Pa 6152 W Corporate Oaks Dr Crystal River FL 34429-8722 Ph: (352) 564-3900 | B Jeffrey Wallis Md Pa 6152 W Corporate Oaks Dr Crystal River FL 34429-8722 Ph: (352) 564-3900 |
| NPI Number | 1003199076 |
|---|---|
| Provider Enumeration Date | 09/26/2011 |
| Last Update Date | 08/07/2012 |
| Medicare PECOS PAC ID | 0446423784 |
|---|---|
| Medicare Enrollment ID | O20111101000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003199076 | NPI | - | NPPES |
| 001690000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Barrett J Wallis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740220938 PECOS PAC ID: 7810942638 Enrollment ID: I20100414000245 |
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