Organization
BRIAN B WALLS MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN B WALLS MD (PHYSICIAN / OWNER)
(321) 243-8593
Entity
Organization
Contact information
Practice address
500 CROCKETT BLVD, MERRITT ISLAND, FL 32953-5034
(321) 243-8593
(321) 454-2523
Mailing address
PO BOX 540033, MERRITT ISLAND, FL 32954-0033
(321) 243-8593
(321) 454-2325
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
09/30/2015
Last updated
05/22/2017
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