Brian B Walls MD PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME71812 Issued in FL

Legal business name

BRIAN B WALLS MD PLLC

Practice address

500 Crockett Blvd
Merritt Island, FL 32953-5034

Phone

(321) 243-8593

Fax

(321) 454-2523

NPI assigned

Sep 30, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Brian B Walls, MDNPI 1508866237

Title

Physician / Owner

Phone

(321) 243-8593

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Bolivar Walls, MD

  • Internal Medicine Physician
  • Merritt Island, FL
  • NPI 1508866237
  Medicare reassignment NPD Authorized official
• Lisa Baker, ARNP FNP-BC

  • Family Medicine Physician
  • Melbourne, FL
  • NPI 1467932525
  Medicare reassignment NPD

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

{
    "created_epoch": "1443571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495411200000",
    "number": "1891165023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 540033",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329540033",
            "telephone_number": "321-243-8593",
            "fax_number": "321-454-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CROCKETT BLVD",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329535034",
            "telephone_number": "321-243-8593",
            "fax_number": "321-454-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN B WALLS MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-30",
        "last_updated": "2017-05-22",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "321-243-8593",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME71812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251358700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Merritt Island, FL
• Providers in Merritt Island, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.