Organization
B JEFFREY WALLIS MD PA
Active
Organization
B JEFFREY WALLIS MD PA
Active
Other names
Advanced Gastroenterology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRETT JEFFREY WALLIS M.D. (OWNER)
(352) 400-8000
Entity
Organization
Contact information
Practice address
6152 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8722
(352) 564-3900
(352) 564-3903
Mailing address
6152 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8722
(352) 564-3900
(352) 564-3906
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001690000
—
FL
Enumeration date
09/26/2011
Last updated
08/07/2012
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