Individual
DR. BRIAN BOLIVAR WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 CROCKETT BLVD, MERRITT ISLAND, FL 32953-5034
(321) 243-8593
Mailing address
PO BOX 540033, MERRITT ISLAND, FL 32954-0033
(321) 243-8593
(321) 453-6280
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME71812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251358700
—
FL
Enumeration date
07/22/2005
Last updated
07/03/2024
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