Organization
RICHARD G WALLIS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD WALLIS MD (PRESIDENT)
(904) 421-2119
Entity
Organization
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204-4748
(904) 421-2119
Mailing address
6255 LAKE GRAY BLVD, SUITE 1, JACKSONVILLE, FL 32244-7502
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME37752
FL
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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