DR. JEROLD W WALLIS (NPI# 1225122567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225122567 |
| Entity Type | Individual |
| Full Name | DR. JEROLD W WALLIS |
| Credential | MD |
| Practice Address |
510 S Kingshighway Blvd Saint Louis MO 63110-1016 |
| Mailing Address |
660 S Euclid Ave C B 8131 Saint Louis MO 63110-1010 |
| Practice Telephone | 3143627200 |
| Practice Fax Number | 3147474189 |
| Mailing Telephone | 3143627200 |
| Mailing Fax Number | 3147474189 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207U00000X | Nuclear Medicine | R9F90 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | ENROLLED | 05 | |
| MO | 209730209 | 05 |
| Street Address |
510 S KINGSHIGHWAY BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033107982 | Laurie L Fajardo | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2005-10-13 |
| 1902442650 | Amir Iravani Tabrizipour | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-11-18 |
| 1942850078 | Paul-robert Derenoncourt | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-09-20 |
| 1659861615 | Alexander Baireddy Reddy | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110 | 2018-05-15 |
| 1508356700 | Daniel Crawford | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-05-14 |
| 1154826675 | Eric Weiner | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-27 |
| 1447754767 | Allison L Schell | Physician Assistant | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-21 |
| 1407381262 | Philip Andrew Velez | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2017-04-28 |
| 1154778959 | Jimmy Xu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2016-05-21 |
| 1124402573 | Wei Wang | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-07-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 207U00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Nuclear Medicine |
| A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease and in research. Radiation detection and imaging instrument systems are used to detect disease as it changes the function and metabolism of normal cells, tissues and organs. A wide variety of diseases can be found in this way, usually before the structure of the organ involved by the disease can be seen to be abnormal by any other techniques. Early detection of coronary artery disease (including acute heart attack), early cancer detection and evaluation of the effect of tumor treatment, diagnosis of infection and inflammation anywhere in the body and early detection of blood clot in the lungs are all possible with these techniques. Unique forms of radioactive molecules can attack and kill cancer cells (e.g., lymphoma, thyroid cancer) or can relieve the severe pain of cancer that has spread to bone |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Nuclear Medicine, 2007. http://www.abnm.org/. A doctor of osteopathy was able to obtain a Certificate of Added Qualifications in the field of Nuclear Medicine. The Certificate is NO longer offered. - American Osteopathic Board of Nuclear Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Nuclear Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477890184 | Syed Sertaj Akhtar | Nuclear Medicine | 1045 Pinegate Dr, Saint Louis, MO 63122-2409 | 2013-01-15 |
| 1740306067 | Asif Moinuddin | Nuclear Medicine | 8985 S Swan Cir, Saint Louis, MO 63144-1717 | 2007-03-21 |
| 1902442650 | Amir Iravani Tabrizipour | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-11-18 |
| 1942850078 | Paul-robert Derenoncourt | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-09-20 |
| 1750728192 | Malak Itani | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2013-05-24 |
| 1962750265 | Rashmi Jain | Nuclear Medicine | 615 S New Ballas Rd, Dept of Nuclear Medicine/radiology, Saint Louis, MO 63141-8221 | 2012-08-17 |
| 1407118318 | Michael S. Moritz | Nuclear Medicine | 615 S New Ballas Rd, Saint Louis, MO 63141 | 2012-06-15 |
| 1104132331 | Garima Agrawal | Nuclear Medicine | 660 S Euclid Ave, Cmps Box 8131, Wash Univ-dept of Nuclear Medicine, Saint Louis, MO 63110-1010 | 2010-08-25 |
| 1154549459 | St Louis University | Nuclear Medicine | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2007-04-23 |
| 1063506392 | Farrokh Dehdashti | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2006-10-03 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.