Individual
DR. JOHN R. WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.MIN.
Contact information
Practice address
1417 SE 4TH ST, FT LAUDERDALE, FL 33301-2319
(954) 463-2273
(954) 779-1643
Mailing address
1417 SE 4TH ST, FT LAUDERDALE, FL 33301-2319
(954) 463-2273
(954) 779-1643
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
MT1251
FL
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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