DR. RICHARD PETERKIN WALLACE (NPI# 1275586448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275586448 |
| Entity Type | Individual |
| Full Name | DR. RICHARD PETERKIN WALLACE |
| Credential | M.D. |
| Practice Address |
1001 S Fort Harrison Ave Suite 101 Clearwater FL 33756-3941 |
| Mailing Address |
1001 S Fort Harrison Ave Suite 101 Clearwater FL 33756-3905 |
| Practice Telephone | 7274415044 |
| Practice Fax Number | 7274415008 |
| Mailing Telephone | 7274415044 |
| Mailing Fax Number | 7274415008 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2016-09-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ME85690 | FL | Allopathic & Osteopathic Physicians |
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
ME85690 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 270183900 | 05 | |
| FL | RAILROAD MEDICARE NUMBER | P00294408 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811434400 | Richard Wallace | Registered Nurse | 4905 Hackamore Dr N, Colorado Springs, CO 80918-2632 | 2017-01-20 |
| 1023242112 | Richard Lance Wallace | Physical Therapist | 1034 Buchanan Bridge Rd, Chesterfield, SC 29709-6154 | 2009-05-05 |
| 1063656262 | Richard Scott Wallace | Social Worker | 10625 Redmond Rd, Austin, TX 78739-1654 | 2009-05-01 |
| 1710105911 | Richard Franklin Wallace | Marriage & Family Therapist | 3341 M St, Merced, CA 95348-2714 | 2007-04-23 |
| 1326199043 | Richard J. Wallace | Counselor | 1930 Stuart St, Berkeley, CA 94703-2215 | 2007-01-16 |
| 1750458402 | Richard Dean Wallace | Nutritionist | 914 13th Ave South, Great Falls, MT 59405 | 2006-11-29 |
| 1427155001 | Richard Lange Wallace | Psychiatry & Neurology | 8858 Scenic Bay Dr, Las Vegas, NV 89117-1026 | 2006-09-17 |
| 1881656940 | Richard M. Wallace | Specialist | 925 Highland Blvd., Suite 1180, Bozeman, MT 59715 | 2006-04-04 |
| 1972596443 | Richard J Wallace | Dentist | 20921 E Smoky Hill Rd, Suite A, Centennial, CO 80015 | 2005-08-30 |
| 1154678332 | Richard Paul Wallace | Pharmacist | Psc 80, Box 13059, Apo, AP 96367-9998 | 2012-08-07 |
| Street Address |
1001 S FORT HARRISON AVE SUITE 101 |
| City | CLEARWATER |
| State | FL |
| Zip Code | 33756-3941 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386177541 | Travis Feldman | Physician Assistant | 1001 S Fort Harrison Ave, #101, Clearwater, FL 33756-3941 | 2017-04-05 |
| 1336537331 | American Integrative Health | General Practice | 1001 S Fort Harrison Ave, Suite 200, Clearwater, FL 33756-3941 | 2014-12-30 |
| 1619257755 | Bayside Urgent Care Center Inc. | Clinic/Center | 1001 S Fort Harrison Ave, Suite 101, Clearwater, FL 33756-3905 | 2011-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659998060 | Guidewell Emergency Medicine Doctors, LLC | Clinic/Center | 1603 Missouri Ave, Clearwater, FL 33756 | 2020-07-01 |
| 1578104527 | M.k. El-yousef, M.d. LLC | Psychiatry & Neurology | 1555 S. Ft Harrison Ave, Clearwater, FL 33756 | 2019-10-01 |
| 1124672670 | Kayla Marie Flook | Counselor | 1106 Druid Rd S Suite 201, Clearwater, FL 33756 | 2019-08-01 |
| 1285192989 | Amy Elizabeth Dickson | Social Worker | 1260 S Mlk Jr Ave Ste D, Clearwater, FL 33756 | 2019-03-12 |
| 1548789951 | J. Carson Woolwine O.d. Pllc. | Optometrist | 912 S. Missouri Ave., Clearwater, FL 33756 | 2017-09-18 |
| 1760912349 | Kelly Morrissey | Counselor | 1240 South Fort Harrison Ave., Clearwater, FL 33756 | 2017-06-15 |
| 1972033744 | Edward Lewis Smith | Audiologist-Hearing Aid Fitter | 820 S Fort Harrison, Clearwater, FL 33756 | 2017-06-14 |
| 1700310422 | Dedicated Senior Medical Center Clearwater, LLC. | Non-Pharmacy Dispensing Site | 855 S Highland Avenue, Dedicated Senior Medical Center St. Clearwater, LLC., Clearwater, FL 33756 | 2017-04-19 |
| 1306268339 | Theresa Anne Ritz | Counselor | 1260 S Martin Luther King Jr Ave Ste D, Clearwater, FL 33756 | 2014-01-10 |
| 1649513276 | Kerry Eileen Reller | Family Medicine | 708 Druid Rd. E, Clearwater, FL 33756 | 2013-04-02 |
| Find all providers in zip 33756 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902354517 | Lance Lieberman | Family Medicine | 25941 Us 19 N, Suite/po 15212, Clearwater, FL 33763-2013 | 2016-09-13 |
| 1295186351 | Kah Development 7, L.L.C. | Family Medicine | 380 Park Place Blvd Ste 230, Clearwater, FL 33759-4930 | 2016-06-29 |
| 1104289115 | Brian Patrick Mcdaniel | Family Medicine | 400 Pinellas St Ste 350, Clearwater, FL 33756-3319 | 2016-03-29 |
| 1225441215 | Michael Gannon | Family Medicine | 2531 Landmark Dr Ste 103, Clearwater, FL 33761-3928 | 2014-06-06 |
| 1467873315 | Community Health Center of Pinellas Inc | Family Medicine | 5523 Roosevelt Blvd, Clearwater, FL 33760-3425 | 2013-12-19 |
| 1588005185 | Nadia Nirmalene Gomes | Family Medicine | 1007 Jeffords St Ste 101, Clearwater, FL 33756-4082 | 2013-07-11 |
| 1649513276 | Kerry Eileen Reller | Family Medicine | 708 Druid Rd. E, Clearwater, FL 33756 | 2013-04-02 |
| 1427323351 | Nancy L Robbin, M.d. Pa | Family Medicine | 2555 Enterprise Rd Ste 9-3, Clearwater, FL 33763-1150 | 2012-03-10 |
| 1679845374 | Inpatient Consultants of Florida, Inc | Family Medicine | 1700 N Mcmullen Booth Rd Ste D1, Clearwater, FL 33759-2129 | 2012-01-27 |
| 1760791859 | Bayside Family Healthcare Clearwater, LLC | Family Medicine | 107 N Mcmullen Booth Rd, Clearwater, FL 33759-4450 | 2010-10-06 |
| Find all providers in CLEARWATER | ||||
| City | CLEARWATER |
| Zip Code | 33756 |
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| 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.