BRIAN ROBERT WALLACE (NPI# 1518118462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518118462 |
| Entity Type | Individual |
| Full Name | BRIAN ROBERT WALLACE |
| Credential | D.O. |
| Practice Address |
1250 Pine Ridge Rd Suite 203 Naples FL 34108-8913 |
| Mailing Address |
3466 Pine Ridge Rd Ste A Naples FL 34109-3883 |
| Practice Telephone | 2362612663 |
| Practice Fax Number | 2392625633 |
| Mailing Telephone | 2392612663 |
| Mailing Fax Number | 2362625633 |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2019-06-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
OS12629 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | MEDICAL LICENSE OH | 34.010952 | 01 |
| FL | MEDICAL LICENSE FL | OS12629 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093866121 | Brian Wallace | Dentist | 781 S Lake Dr, Suite 1, Prestonsburg, KY 41653-1340 | 2007-01-16 |
| 1801864350 | Brian Wallace | Internal Medicine | 9005 Kilbride Rd, Baltimore, MD 21236-2017 | 2006-03-10 |
| 1831198811 | Brian David Wallace | Radiology | 1100 Brookhaven Rd, Franklin, KY 42134-2746 | 2005-07-20 |
| 1861939845 | Brian Wallace | Counselor | 7907 Ostrow St Ste F, San Diego, CA 92111-3635 | 2017-01-27 |
| 1114378759 | Brian Charles Wallace | Physician Assistant | 125 W Catawba Ave, Mount Holly, NC 28120-1601 | 2016-06-24 |
| 1154677359 | Brian Venson Wallace | Physical Therapist | 711 Avignon Dr, Ridgeland, MS 39157-5120 | 2012-07-25 |
| 1598083495 | Brian William Wallace | Chiropractor | 139 Morristown Rd, Bernardsville, NJ 07924-2633 | 2010-05-17 |
| 1790017028 | Brian Edward Wallace | Anesthesiology | 400 E Pioneer Ave, Suite 101, Puyallup, WA 98372-3255 | 2010-02-11 |
| 1518124627 | Brian Scott Wallace | Emergency Medicine | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2008-05-18 |
| 1427248350 | Brian J Wallace | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2007-07-26 |
| Street Address |
1250 PINE RIDGE RD SUITE 203 |
| City | NAPLES |
| State | FL |
| Zip Code | 34108-8913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558326538 | Henry Kurtis Biggs | Orthopaedic Surgery | 1250 Pine Ridge Rd, Naples, FL 34108-8913 | 2006-04-20 |
| 1093250763 | Dana Zeitler | Physician Assistant | 1250 Pine Ridge Rd, Naples, FL 34108-8913 | 2017-01-04 |
| 1548653033 | Cosmetic and Wellness Associates of Naples, LLC | Internal Medicine | 1250 Pine Ridge Rd, Naples, FL 34108-8913 | 2015-03-09 |
| 1245581438 | William Michael Fazio | Physician Assistant | 1250 Pine Ridge Rd, Suite 203, Naples, FL 34108-8913 | 2012-09-27 |
| 1659662666 | Katherine A Snyder | Nurse Practitioner | 1250 Pine Ridge Rd, #101a, Naples, FL 34108-8913 | 2011-04-25 |
| 1609005230 | Excel Physical Therapy of Naples, Inc. | Clinic/Center | 1250 Pine Ridge Rd, Suite 3, Naples, FL 34108-8913 | 2009-07-02 |
| 1568699973 | Juan Carlos Quiroga | Physical Therapist | 1250 Pine Ridge Rd, Suite # 3, Naples, FL 34108-8913 | 2009-06-12 |
| 1891912606 | Clinton Dwayne Crawford | Physical Therapist | 1250 Pine Ridge Rd, Suite 203, Naples, FL 34108-8913 | 2007-04-20 |
| 1013068089 | Jamie Elise Weaver | Podiatrist | 1250 Pine Ridge Rd, Suite 203, Naples, FL 34108-8913 | 2007-01-16 |
| 1912083254 | Advance Medical of Naples | Clinic/Center | 1250 Pine Ridge Rd, Naples, FL 34108-8913 | 2006-10-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417422262 | Alejandra Herrera Munoz | Occupational Therapist | 646 103rd Ave N, Naples, FL 34108 | 2018-10-08 |
| 1912402983 | Cvs Aoc Services, L.L.C. | Audiologist-Hearing Aid Fitter | 8863h Tamiami Trl N, Naples, FL 34108 | 2018-03-29 |
| 1861886863 | Zounds Hearing | Durable Medical Equipment & Medical Supplies | 9331 Tamiami Trail, Naples, FL 34108 | 2015-03-27 |
| 1750651220 | Dr. Alfonso Olivos, P.a. | Family Medicine | 873 101 Avenue N., Naples, FL 34108 | 2011-12-30 |
| 1083901367 | Gregory Alan Mazur | Podiatrist | 9915 Tamiami Trl N Ste 1, Naples, FL 34108 | 2011-07-07 |
| 1124253398 | G B Fisher IIi Do Pa | Ophthalmology | 875 105 Ave North, Naples, FL 34108 | 2009-05-18 |
| 1134378466 | Susanna Alis | Counselor | 9853 Tamiami Trl N Ste 227c, Naples, FL 34108 | 2008-09-10 |
| 1194995720 | William Nicholas Sullivan | Dentist | 6100 Trail Blvd North, Suite 1, Naples, FL 34108 | 2008-03-11 |
| 1285838219 | John Woolman Cox | Dermatology | 650 Bridgeway Lane, Naples, FL 34108 | 2007-06-13 |
| 1780888263 | Gerald Frank Levens | Family Medicine | 1175 Creekside Pkwy Ste 200, Naples, FL 34108 | 2007-06-11 |
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| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992775589 | Michael Terrance Havig | Orthopaedic Surgery | 1250 Pine Ridge Rd Ste 202, Naples, FL 34108-8913 | 2006-01-25 |
| 1467642363 | Collier Sports Medicine and Orthopaedic Center Pa | Orthopaedic Surgery | 1706 Medical Blvd, Suite 201, Naples, FL 34110-1400 | 2007-07-26 |
| 1144290206 | Philip T Regala | Orthopaedic Surgery | 1350 Tamiami Trl N, Ste 203, Naples, FL 34102-5203 | 2006-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801401021 | Ortho Florida, LLC | Orthopaedic Surgery | 17425 7th St Ste 560174, Montverde, FL 34756-3206 | 2020-09-14 |
| 1801429022 | Ortho Florida, LLC | Orthopaedic Surgery | 2122 W Cypress Creek Rd Ste 202, Ft Lauderdale, FL 33309-1858 | 2020-02-17 |
| 1750913141 | Tyrance Orthopedics and Sports Medicine | Orthopaedic Surgery | 1620 S Congress Ave Ste 201, Palm Springs, FL 33461-2128 | 2020-02-04 |
| 1255979076 | Ortho Florida, LLC | Orthopaedic Surgery | 2122 W Cypress Crk Rd Ste 202, Fort Lauderdale, FL 33309-1858 | 2019-12-11 |
| 1730740218 | Baptist Physician Group LLC | Orthopaedic Surgery | 133 Racetrack Rd Nw, Fort Walton Beach, FL 32547-1644 | 2019-06-25 |
| 1164984720 | Ortho Florida, LLC | Orthopaedic Surgery | 21097 Ne 27th Ct Ste 590, Aventura, FL 33180-1246 | 2019-04-03 |
| 1578043998 | Bahri Orthopedics Institute | Orthopaedic Surgery | 6100 Kennerly Rd Ste 202, Jacksonville, FL 32216-4379 | 2018-08-15 |
| 1154834489 | Dorothy Richardson | Orthopaedic Surgery | 1120 W Lakeshore Dr, Clermont, FL 34711-2936 | 2017-11-08 |
| 1225541790 | Ortho Florida, LLC | Orthopaedic Surgery | 3702 Washington St Ste 202, Hollywood, FL 33021-8283 | 2017-11-07 |
| 1275046831 | Galaxy Wellness Sport and Rehabilitation Center LLC | Orthopaedic Surgery | 1951 Nw 7th St, Miami, FL 33125 | 2017-11-06 |
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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.