Organization Active NPI

Gary S Wallach DPM PA

  • Foot Surgery Podiatrist
  • Ft Lauderdale, FL
National Provider Identifier
1013020924
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
Legal business name
GARY S WALLACH DPM PA
Practice address
2737 E Oakland Park Blvd
Ft Lauderdale, FL 33306-1641
Phone
(954) 561-3338
Fax
(954) 566-3051
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

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

Authorized official

Name
Dr. Gary S Wallach, D.P.M.
Title
President
Phone
(954) 561-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X FL Primary

Addresses

Primary practice location

2737 E Oakland Park Blvd
Ft Lauderdale, FL 33306-1641

Mailing address

2737 E Oakland Park Blvd
Ft Lauderdale, FL 33306-1641
Phone (954) 561-3338

Other identifiers 2

IdentifierTypeStateIssuer
041067500MedicaidFL
DN9665OtherFLRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

2737 E Oakland Park Blvd
Ft Lauderdale, FL 33306
Phone (954) 558-4084

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1013020924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2737 E OAKLAND PARK BLVD",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061641",
            "telephone_number": "954-561-3338",
            "fax_number": "954-566-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 E OAKLAND PARK BLVD",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061641",
            "telephone_number": "954-561-3338",
            "fax_number": "954-566-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY S WALLACH DPM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "WALLACH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-561-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041067500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DN9665",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.