Wallace E. Combs, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME 10909 Issued in FL

Practice address

5325 Woodhaven LN
Lakeland, FL 33813-2657

Phone

(863) 619-5623

Fax

(863) 619-5623

NPI assigned

Jun 19, 2007

Last updated

Jun 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Locations

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

• Halifax Healthcare Systems Inc

  dba HHCSI Halifax Family Health Center

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530
  Medicare reassignment NPD

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1376748269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 WOODHAVEN LN",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132657",
            "telephone_number": "863-619-5623",
            "fax_number": "863-619-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 WOODHAVEN LN",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132657",
            "telephone_number": "863-619-5623",
            "fax_number": "863-619-5623"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Home Rd",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "KY",
            "postal_code": "410115634",
            "country_code": "US",
            "telephone_number": "859-261-8768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COMBS",
        "first_name": "WALLACE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "13057",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME 10909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nayely Colon Martinez
• Julyssa Colon, CRNA
• Steven John Colucci, DO
• Cassidy Kate Colwell, MD
• Caitlin A Combs, MD
• Comfortable Care Denta Health Professionals, PA (Family Dental at Lakeside Village)
• Comfortable Care Dental Health Professionals (Lake Gibson Dental Center)
• Comfortable Care Dental Health Professionals (Lakeland Dentistry)
• Comfortable Care Dental Health Professionals, P.a. (Kathleen Dental Care)
• Comfortable Care Dental Health Professionals, P.a. (Highland City Dental Care)

• Child & Adolescent Psychiatry Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.