Richard G Wallis MD PA

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

ME37752 Issued in FL

Legal business name

RICHARD G WALLIS MD PA

Practice address

1 Shircliff Way
Jacksonville, FL 32204-4748

Phone

(904) 421-2119

NPI assigned

Feb 13, 2012

Organization subpart

No

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

Authorized official

Name

Richard Wallis, MD

Title

President

Phone

(904) 421-2119

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329091200000",
    "number": "1801169412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 LAKE GRAY BLVD",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322447502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044748",
            "telephone_number": "904-421-2119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD G WALLIS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-13",
        "last_updated": "2012-02-13",
        "status": "A",
        "authorized_official_last_name": "WALLIS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-421-2119",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME37752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn K. Rich, MSW
• Lauren Michelle Rich
• Meshall D Rich
• Richard C. Mullens, DDS PLLC
• Richard E. Nay PHD Inc
• Richard M Blecha, M.D., LLC
• Richard W Blake DDS PA
• Alyssia Richard
• Dermon Richard Jr.
• Greggory Richard, PTT, DPT

• Anesthesiology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Anesthesiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; 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.