DR. ROBERT JENNINGS WALLACE (NPI# 1821396151) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821396151 |
| Entity Type | Individual |
| Full Name | DR. ROBERT JENNINGS WALLACE |
| Credential | MD |
| Practice Address |
3000 1st Ave N St Petersburg FL 33713-8607 |
| Practice Telephone | 7278260700 |
| Practice Fax Number | 7279546994 |
| Mailing Telephone | 7278260700 |
| Mailing Fax Number | 7279546994 |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
ME 42522 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 014630900 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 721 Dr Martin Luther King Jr St S, St Petersburg, FL 337051922 | 7272281650 | 7279546994 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316430176 | Robert E Wallace | Case Manager/Care Coordinator | 283 Old Colliers Way, Weirton, WV 26062-4073 | 2018-06-07 |
| 1801337134 | Robert William Wallace II | Student in an Organized Health Care Education/Training Program | 204 N Silver Maple Dr, Slidell, LA 70458-5483 | 2017-03-20 |
| 1780015610 | Robert G. Wallace | Radiology | 1130 Goat Rock Road, Fortson, GA 31808 | 2013-12-03 |
| 1972947257 | Robert William Wallace | Registered Nurse | 40 Ridge Dr, West Hurley, NY 12491-5627 | 2013-04-17 |
| 1487991683 | Robert J Wallace | Acupuncturist | 1619 W Montrose, Chicago Holistic Medicine, Chicago, IL 60613 | 2013-01-08 |
| 1154582773 | Robert Lee Wallace | Counselor | 110 S Hancock St, Rockingham, NC 28379-3675 | 2008-06-17 |
| 1649484635 | Robert Jay Wallace | Obstetrics & Gynecology | 6250 Alfred Harrell Hwy, Bakersfield, CA 93308-9654 | 2007-05-09 |
| 1023132644 | Robert S Wallace | Chiropractor | 7 Centre Dr, Suite 10, Monroe, NJ 08831-1565 | 2007-03-19 |
| 1750443024 | Robert Wallace | Pharmacist | 12421 W Denton Ave, Litchfield Park, AZ 85340-3435 | 2006-12-14 |
| 1922113174 | Robert Vernon Wallace | Family Medicine | 400 Lee Blvd, Lehigh Acres, FL 33936-4923 | 2006-08-20 |
| Street Address |
3000 1ST AVE N |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33713-8607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154371714 | Ernst E. Vieux, Jr., M.d., P.a. | Surgery | 3000 1st Ave N, St Petersburg, FL 33713-8607 | 2006-05-12 |
| 1538799747 | Craig F Callam-olaguibel | Registered Nurse | 3000 1st Ave N, St Petersburg, FL 33713-8607 | 2020-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073122230 | Busy Bee Aba Therapy LLC | Assistant Behavior Analyst | 441 33rd Street North #407, St. Petersburg, FL 33713 | 2020-07-23 |
| 1902428899 | Taylor Lorraine Fowler | Behavior Technician | 7381 114th Ave, Suite 405 Largo Fl 33773, Suite 405, St. Petersburg, FL 33713 | 2020-05-13 |
| 1770120180 | Mai Family and Sedation Dentistry, Pa | Dentist | 495 31st Street North, St. Petersburg, FL 33713 | 2019-12-04 |
| 1932672524 | Julie Marlowe Gilbert | Dermatology | 2191 9th Ave North, Ste. 100, St. Petersburg, FL 33713 | 2019-01-07 |
| 1962992024 | Lauren Elizabeth Oloughlin | Nurse Practitioner | 1001 37th St N Ste C, St Petersburg, FL 33713 | 2018-05-15 |
| 1447766316 | Melanie Marie Byrne | Assistant Behavior Analyst | 5185 45th St N, Bldg C, St. Petersburg, FL 33713 | 2017-12-14 |
| 1942679683 | Teresa E Peak | Physician Assistant | 2191 9th Ave N St 220, St. Petersburg, FL 33713 | 2015-09-23 |
| 1639555204 | Priya Panara | Internal Medicine | 2299 9th Ave N Ste 1f, St Petersburg, FL 33713 | 2015-08-06 |
| 1730568635 | Kevin Michael Carbonell | Dentist | 3863 Central Avenue, Saint Petersburg, FL 33713 | 2015-05-26 |
| 1558752972 | Sage Program, LLC | Community/Behavioral Health | 3530 1st Avenue North, Suite 111, St. Petersbrug, FL 33713 | 2015-02-06 |
| Find all providers in zip 33713 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164836797 | Pinellas Health & Wellness, LLC | Family Medicine | 222 2nd St N, St Petersburg, FL 33701-3314 | 2014-06-11 |
| 1306111737 | Norval Mason Marr Jr. | Family Medicine | 501 Coffee Pot Riviera Ne, St Petersburg, FL 33704-3617 | 2012-03-19 |
| 1205036555 | K Jean Joviak Md Pa | Family Medicine | 860 S Village Dr N, 105, St Petersburg, FL 33716-3024 | 2007-07-24 |
| 1932298411 | Margaret Teresa Nusca | Family Medicine | 690 4th Ave S, St Petersburg, FL 33701 | 2006-10-12 |
| 1851344485 | John E Kern | Family Medicine | 5838 9th Ave N, St Petersburg, FL 33710-6319 | 2006-05-17 |
| 1811498652 | Tampa Bay Hospitalists LLC | Family Medicine | 1839 Central Ave, St Petersburg, FL 33713-8900 | 2018-02-27 |
| 1932598349 | Clear Path Center Pa | Family Medicine | 3177 4th St N, St Petersburg, FL 33704-2124 | 2015-01-22 |
| 1427394303 | Capital Medical Group, LLC | Family Medicine | 5985 49th St N, St Petersburg, FL 33709-2111 | 2012-12-20 |
| 1003116625 | John E Kern Do Pa | Family Medicine | 5838 9th Ave N, St Petersburg, FL 33710-6319 | 2010-10-29 |
| 1760625099 | Gregory W. Nestor, Md, LLC | Family Medicine | 7655 38th Ave N, Suite 202, St Petersburg, FL 33710-1263 | 2009-04-16 |
| Find all providers in ST PETERSBURG | ||||
| City | ST PETERSBURG |
| Zip Code | 33713 |
Please comment or provide details below to improve the information on DR. ROBERT JENNINGS WALLACE.
| 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.