Wall Dermatology, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

WALL DERMATOLOGY, LLC

Practice address

1700 66TH St N Ste 300
St Petersburg, FL 33710-5500

Phone

(727) 432-3225

NPI assigned

Apr 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Weston Wall, MDNPI 1437512969

Title

Physician Owner

Phone

(727) 432-3225

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Weston Wall, MD

  • MOHS-Micrographic Surgery Physician
  • St Petersburg, FL
  • NPI 1437512969
  Medicare reassignment NPD Authorized official
• Aleece Allbritton, PA-C

  • Physician Assistant
  • St Petersburg, FL
  • NPI 1437864832
  Medicare reassignment
• Brittany Tanner Abud, MD

  • Otolaryngology Physician
  • Chicago, IL
  • NPI 1386104891

  FL

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1003668328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 BOCA CIEGA DR N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337102834",
            "telephone_number": "727-432-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 66TH ST N STE 300",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337105500",
            "telephone_number": "727-432-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALL DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "WESTON",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "727-432-3225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pauline Marion Walker, RD,LD
• Phillip N Walker, LCSW
• Randall Kent Walker, PTA
• Sharla Walker, NP
• Travis Aaron Walker, MD
• Kimberly Wall, CRT
• Weston Wall, MD
• Anna Joan Wallace, COTA
• Jennifer L Wallace, P.T.
• Jennifer Lea Wallace, PAC

• MOHS-Micrographic Surgery Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• MOHS-Micrographic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.