Individual
BARRETT JEFFREY WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6152 W CORPORATE OAKS DR, CRYSTAL RIVER, FL 34429-8722
(352) 564-3900
(352) 564-3906
Mailing address
835 SE 1ST CT, CRYSTAL RIVER, FL 34429-4612
(352) 400-8000
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
35.088718
OH
207RG0100X
Gastroenterology Physician
Primary
ME48685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001690000
—
FL
01
—
12042524
MULTIPLAN
NY
01
—
1299092
GHI GROUP HEALTH INC
NY
01
—
146VV
BCBS OF FLORIDA
FL
01
—
333619
AVMED
FL
Enumeration date
06/07/2006
Last updated
10/10/2024
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