Richard B Wallace (NPI# 1457442477, PAC ID# 7810932126) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PSYCHIATRY.
| Nation Provider ID (NPI) | 1457442477 |
| PAC ID by PECOS | 7810932126 |
| Professional Enrollment ID | I20150410002115 |
| Full Name | Richard B Wallace |
| Organization Legal Name | LIFESTREAM BEHAVIORAL CENTER INC |
| Address |
215 N 3rd St Leesburg FL 34748-5105 |
| Phone Number | 3523157900 |
| Gender | M |
| Credential | DO |
| Medical School | KIRKSVILLE COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 1987 |
| Primary Specialty | PSYCHIATRY |
| Group Practice PAC ID | 7012992720 |
| Number of Group Practice Members | 19 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 215 N 3rd St, Leesburg, FL 34748-5105 | 3523157900 | LIFESTREAM BEHAVIORAL CENTER INC |
| Organization Legal Name | LIFESTREAM BEHAVIORAL CENTER INC |
| Physicians | 22 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Natasha O Vernon | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Edeline Dardignac | Nurse Practitioner | Lifestream Behavioral Center Inc | 2140 N Don Wickham Dr, Clermont, FL 34711-1962 |
| Nageley J Michel | Nurse Practitioner | Lifestream Behavioral Center Inc | 2020 Talley Rd, Leesburg, FL 34748-3426 |
| David A Dada | Psychiatry | Lifestream Behavioral Center Inc | 2018 Talley Rd, Leesburg, FL 34748-3426 |
| Carol Anne Couts | Psychiatry | Lifestream Behavioral Center Inc | 201 E Magnolia Ave, Eustis, FL 32726-3583 |
| Amanda V Craig Smith | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Julie M Conrad | Nurse Practitioner | Lifestream Behavioral Center Inc | 2140 N Don Wickham Dr, Clermont, FL 34711-1962 |
| Barbara Gurgen | Nurse Practitioner | Lifestream Behavioral Center Inc | 2020 Talley Rd, Leesburg, FL 34748-3426 |
| William Whitman | Psychiatry | Lifestream Behavioral Center Inc | 201 E Magnolia Ave, Eustis, FL 32726-3583 |
| Patricia Rogers | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Street Address |
215 N 3RD ST |
| City | LEESBURG |
| State | FL |
| Zip | 34748-5105 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Natasha O Vernon | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Amanda V Craig Smith | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Patricia Rogers | Nurse Practitioner | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Saad Siddiqui | Physician Assistant | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Edgar A Walker Jr. | Psychiatry | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Jessica Bowers | Clinical Social Worker | Lifestream Behavioral Center Inc | 215 N 3rd St, Leesburg, FL 34748-5105 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Miratiqullah Hessami | Internal Medicine | E Dixie Ave, Leesburg, FL 34748 | |
| Mohammad A Choudhry | Neurology | 26218 Us Hwy 27 105, Leesburg, FL 34748-1708 | |
| Wayne Hu | Physical Medicine and Rehabilitation | Lakeview Healthcare System, LLC | 1801 Us Hwy 441, Bldg 100, Leesburg, FL 34748-2545 |
| Anette V Nieves | Neurology | 2500 Citrus Blvd, Leesburg, FL 34748-3063 | |
| Nageley J Michel | Nurse Practitioner | Lifestream Behavioral Center Inc | 2020 Talley Rd, Leesburg, FL 34748-3426 |
| David A Dada | Psychiatry | Lifestream Behavioral Center Inc | 2018 Talley Rd, Leesburg, FL 34748-3426 |
| Barbara Gurgen | Nurse Practitioner | Lifestream Behavioral Center Inc | 2020 Talley Rd, Leesburg, FL 34748-3426 |
| Praxides Mbakaya-chen | Nurse Practitioner | Lifestream Behavioral Center Inc | 2020 Talley Rd, Leesburg, FL 34748-3426 |
| Miguel A Correa | Psychiatry | Lifestream Behavioral Center Inc | 2018 Talley Rd, Leesburg, FL 34748-3426 |
| Margaret Yearwood | Physician Assistant | Lifestream Behavioral Center Inc | 2018 Talley Rd, Leesburg, FL 34748-3426 |
| Find all physicians in zip 34748 | |||
| City | LEESBURG |
| Zip Code | 34748 |
| Specialty | PSYCHIATRY |
| City + Specialty | LEESBURG + PSYCHIATRY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.