Individual
MERVIN P WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1264 METROPOLITAN BLVD, TALLAHASSEE, FL 32312-2536
(850) 383-3471
Mailing address
PO BOX 15349, TALLAHASSEE, FL 32317-5349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME95779
FL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME95779
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276781300
—
FL
01
—
P00964768
MEDICARE RR
FL
Enumeration date
07/18/2006
Last updated
01/08/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us