William Arthur Wallace Jr., M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

ME107749 Issued in FL

Practice address

1679 Eagle Harbor Pkwy
Suite C
Fleming Island, FL 32003-4815

Phone

(904) 348-0727

Fax

(904) 621-9272

NPI assigned

Apr 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fleming Island Plastic Surgery LLC

  • Plastic and Reconstructive Surgery Physician
  • Fleming Island, FL
  • NPI 1245602069
  Medicare reassignment Authorized official
• Fleming Island Plastic Surgery LLC

  • Plastic Surgery Physician
  • Fleming Island, FL
  • NPI 1497128953
  NPD (past)

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

{
    "created_epoch": "1177200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446336000000",
    "number": "1184842627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1679 EAGLE HARBOR PKWY",
            "address_2": "SUITE C",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034815",
            "telephone_number": "904-348-0727",
            "fax_number": "904-621-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1679 EAGLE HARBOR PKWY",
            "address_2": "SUITE C",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034815",
            "telephone_number": "904-348-0727",
            "fax_number": "904-621-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-22",
        "last_updated": "2015-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "FL",
            "license": "ME107749",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "OH",
            "license": "35.079632",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol A Visconti
• Lenora A. Waddell
• Michael Brent Wade Jr., LMHC
• Michael Wayne Walker, PT/ATC
• Paul A Walker, M.D.
• Lauren Kay Walter, N.P.
• Jordan T Waltrip
• Riley Ward
• Louis Andrew Warmijak, APRN
• Shelly Warner

• Plastic and Reconstructive Surgery Physician in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.