DR. ROBERT JENNINGS WALLACE MD AAHIVS NPI 1821396151

NPI Information

NPI: 1821396151
Provider Name: DR. ROBERT JENNINGS WALLACE, MD, AAHIVS
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
3000 1ST AVE N
ST PETERSBURG, FL
ZIP 33713
Phone: (727) 826-0700
Get Directions

DR. Robert Jennings Wallace, MD, AAHIVS is a general practice in St Petersburg, FL with 42 years of experience. DR. Robert Jennings Wallace, MD, AAHIVS NPI is 1821396151. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Graduation Year:1982

The provider's business location address is:

3000 1ST AVE N
ST PETERSBURG, FL
ZIP 33713-607
Phone: (727) 826-0700
Fax: (727) 954-6994

The NPI 1821396151 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/10/2011 and was last updated on 6/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0505X	Family Medicine	Adult Medicine	ME 42522	FLORIDA	No
2	207Q00000X	Family Medicine		ME42522	FLORIDA	No
3	208D00000X	General Practice		ME42522	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000121140	OTHER		UNITED INSURANCE
2	189052	OTHER		CIGNA
3	05595987	OTHER		CLEAR
4	111163300	MEDICAID	FLORIDA
5	14NU6	OTHER	FLORIDA	FLORIDA BLUE
6	14NU6	OTHER		FLORIDA BLUE
7	1108108	OTHER	FLORIDA	STAYWELL
8	14NU6	OTHER	FLORIDA	BLUE CROSS BLUE SHIELD
9	0007618489	OTHER		AETNA
10	11382461	OTHER	FLORIDA	CAQH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »