DR. JEROLD W WALLIS


Address: 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016
Phone: 3143627200

DR. JEROLD W WALLIS (NPI# 1225122567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1225122567
Entity Type Individual
Full Name DR. JEROLD W WALLIS
Credential MD
Practice Address 510 S Kingshighway Blvd
Saint Louis
MO 63110-1016
Mailing Address 660 S Euclid Ave
C B 8131
Saint Louis
MO 63110-1010
Practice Telephone 3143627200
Practice Fax Number 3147474189
Mailing Telephone 3143627200
Mailing Fax Number 3147474189
Enumeration Date 2006-10-03
Last Update Date 2018-01-29
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207U00000X Nuclear Medicine R9F90 MO Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL ENROLLED 05
MO 209730209 05

Office Location

Street Address 510 S KINGSHIGHWAY BLVD
City SAINT LOUIS
State MO
Zip Code 63110-1016

Providers in the same location

NPI Name Taxonomy Address Enumeration
1033107982 Laurie L Fajardo Radiology 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2005-10-13
1902442650 Amir Iravani Tabrizipour Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2019-11-18
1942850078 Paul-robert Derenoncourt Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2019-09-20
1659861615 Alexander Baireddy Reddy Radiology 510 S Kingshighway Blvd, Saint Louis, MO 63110 2018-05-15
1508356700 Daniel Crawford Student in an Organized Health Care Education/Training Program 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2018-05-14
1154826675 Eric Weiner Student in an Organized Health Care Education/Training Program 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2018-03-27
1447754767 Allison L Schell Physician Assistant 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2018-03-21
1407381262 Philip Andrew Velez Student in an Organized Health Care Education/Training Program 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2017-04-28
1154778959 Jimmy Xu Radiology 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2016-05-21
1124402573 Wei Wang Radiology 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 2015-07-15
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1659971992 Carrie Ellen Smith Nurse Practitioner Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 2020-10-27
1881210466 Michelle Amanda Freilich Internal Medicine Barnes-jewish Plaza, St. Louis, MO 63110 2020-06-19
1245856046 Jeevin Shahi Radiology 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 2020-06-18
1497371314 Wilson Eduardo Rodriguez Student in an Organized Health Care Education/Training Program 1008 S. Spring, St Louis, MO 63110 2020-06-17
1578184065 Kathryn Kay Lindsay Registered Nurse Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 2020-05-06
1881232700 Ashley Diane Pace Nurse Practitioner 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 2019-12-11
1619520418 Krithika Damodar Shenoy Pathology 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 2019-07-20
1467912550 Ian Ferguson Dermatology 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 2019-03-23
1760978688 Ihab Hassanieh Student in an Organized Health Care Education/Training Program 33660 Vista Ave, St. Louis, MO 63110 2018-07-03
1336634500 Martin K Mwangi Pediatrics 1 Childrens Place, 3s34, St. Louis, M, MO 63110 2018-06-28
Find all providers in zip 63110

Taxonomy Information

Taxonomy Code 207U00000X
Grouping Allopathic & Osteopathic Physicians
Classification Nuclear Medicine

Taxonomy Definition

A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease and in research. Radiation detection and imaging instrument systems are used to detect disease as it changes the function and metabolism of normal cells, tissues and organs. A wide variety of diseases can be found in this way, usually before the structure of the organ involved by the disease can be seen to be abnormal by any other techniques. Early detection of coronary artery disease (including acute heart attack), early cancer detection and evaluation of the effect of tumor treatment, diagnosis of infection and inflammation anywhere in the body and early detection of blood clot in the lungs are all possible with these techniques. Unique forms of radioactive molecules can attack and kill cancer cells (e.g., lymphoma, thyroid cancer) or can relieve the severe pain of cancer that has spread to bone
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Nuclear Medicine, 2007. http://www.abnm.org/. A doctor of osteopathy was able to obtain a Certificate of Added Qualifications in the field of Nuclear Medicine. The Certificate is NO longer offered.
- American Osteopathic Board of Nuclear Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Nuclear Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1477890184 Syed Sertaj Akhtar Nuclear Medicine 1045 Pinegate Dr, Saint Louis, MO 63122-2409 2013-01-15
1740306067 Asif Moinuddin Nuclear Medicine 8985 S Swan Cir, Saint Louis, MO 63144-1717 2007-03-21
1902442650 Amir Iravani Tabrizipour Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2019-11-18
1942850078 Paul-robert Derenoncourt Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2019-09-20
1750728192 Malak Itani Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2013-05-24
1962750265 Rashmi Jain Nuclear Medicine 615 S New Ballas Rd, Dept of Nuclear Medicine/radiology, Saint Louis, MO 63141-8221 2012-08-17
1407118318 Michael S. Moritz Nuclear Medicine 615 S New Ballas Rd, Saint Louis, MO 63141 2012-06-15
1104132331 Garima Agrawal Nuclear Medicine 660 S Euclid Ave, Cmps Box 8131, Wash Univ-dept of Nuclear Medicine, Saint Louis, MO 63110-1010 2010-08-25
1154549459 St Louis University Nuclear Medicine 3635 Vista Ave, Saint Louis, MO 63110-2539 2007-04-23
1063506392 Farrokh Dehdashti Nuclear Medicine 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 2006-10-03
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City SAINT LOUIS
Zip Code 63110

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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