SCOTT ANDREW WALLACE (NPI# 1275809899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275809899 |
| Entity Type | Individual |
| Full Name | SCOTT ANDREW WALLACE |
| Credential | M.D. |
| Practice Address |
Navy Medicine Support Command Attn: Med Staff Services Bldg H 2005 Knight Lane Jacksonville FL 32212-0140 |
| Mailing Address |
11410 Interlaaken Dr Sw Lakewood WA 98498-5522 |
| Practice Telephone | 6195327935 |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-03-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184996399 | Scott D Wallace | Social Worker | 63 Glenwood St, Lowell, MA 01852-3007 | 2012-02-02 |
| 1629139563 | Scott Matthew Wallace | Chiropractor | 8960 W Cheyenne Ave, Suite 110, Las Vegas, NV 89129-8929 | 2006-12-13 |
| 1770655342 | Scott G Wallace | Chiropractor | 2515 Crosby Ave, Klamath Falls, OR 97603-4553 | 2006-11-15 |
| 1558381822 | Scott Christopher Wallace | Anesthesiology | Po Box 112, Muncie, IN 47308-0112 | 2006-07-20 |
| 1831611839 | Scott Christopher Wallace | Nurse Practitioner | 1900 S Main St, Findlay, OH 45840-1214 | 2017-07-11 |
| 1104359975 | Scott Robert Wallace | Psychiatry & Neurology | 103 N Loop 499, Harlingen, TX 78550-2557 | 2017-04-07 |
| 1922441880 | Scott Michael Wallace | Pediatrics | 75 Pringle Way, Ste 300, Reno, NV 89502-1464 | 2013-04-10 |
| 1134414220 | Scott Eric Wallace | Pharmacist | 1214 N Market Blvd, Suite C, Sacramento, CA 95834-2931 | 2011-06-16 |
| 1568755114 | Scott Wallace | Technician, Other | 4801 Reading St, Dallas, TX 75247-6716 | 2011-05-16 |
| 1265613855 | Scott Arthur Wallace | Physician Assistant | 3643 N Roxboro St, Durham Regional Hospital Emergency Department, Durham, NC 27704-2702 | 2007-11-25 |
| Street Address |
NAVY MEDICINE SUPPORT COMMAND ATTN: MED STAFF SERVICES BLDG H 2005 KNIGHT LANE |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32212-0140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952911752 | Jeff Woohyeok Chang | Dentist | 964 Ajax Street, Jacksonville, FL 32212 | 2020-08-06 |
| 1518484427 | Amy Kathryn Lee | Student in an Organized Health Care Education/Training Program | Bumed, Centralized Credential & Privileging Directorate, 554 Keily Street, Jacksonville, FL 32212 | 2017-08-23 |
| 1659827970 | Noah Fixelle | Dentist | Bureau of Med and Surg Ccpd, 554 Keily Street, Jacksonville, VA 32212 | 2016-08-28 |
| 1972953339 | Colin Kenneth Kelly | General Practice | Bureau of Medicine & Surgery Detachment, Nas Jacksonville, Building 554, Jacksonville, FL 32212 | 2016-06-16 |
| 1912382359 | Caitlyn Brooke Hoysock | Dentist | 554 Keiley Street, Bureau of Medicine and Surgery - Credentials, Jacksonville, FL 32212 | 2015-07-28 |
| 1285017418 | John Alexander Ruch | Dentist | 554 Keily Street Bureau of Med and Surg Ccpd, Jacksonville, FL 32212 | 2015-07-07 |
| 1407238561 | Amanda Mona Lau | Student in an Organized Health Care Education/Training Program | 554 Kelly Street, Attn Centralized Credentialing, Bureau of Medicine and Surgery, Jacksonville, FL 32212 | 2015-06-25 |
| 1063894715 | Heather Dehaan | Family Medicine | 554 Kelly Street Bureau of Medicine and Surgery, Attention: Centralized Credentialing & Privileging Dire, Jacksonville, FL 32212 | 2015-06-18 |
| 1912389677 | Catherine Garcia | Student in an Organized Health Care Education/Training Program | 554 Kelly St, Credentialing & Privileging Directorate, Bureau of Medicine & Surgery, Attention: Centralized, Jacksonville, FL 32212 | 2015-06-18 |
| 1255712675 | James Robert Benson | Dentist | 734 Keily Street, Bumed, Jacksonville, FL 32212 | 2015-06-11 |
| Find all providers in zip 32212 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548860711 | Lee Thomas Hagenbaumer | Student in an Organized Health Care Education/Training Program | 10100 Baymeadows Rd Apt 802, Jacksonville, FL 32256-7196 | 2020-10-27 |
| 1508463456 | Juana Maria Hodac | Student in an Organized Health Care Education/Training Program | 8680 Baymeadows Rd E Apt 1018, Jacksonville, FL 32256-3994 | 2020-10-05 |
| 1366053043 | Amanda Brunner | Student in an Organized Health Care Education/Training Program | 404 Henry Rd Sw, Jacksonville, AL 36265-3338 | 2020-08-14 |
| 1528679206 | Deandrea Joice Stowe | Student in an Organized Health Care Education/Training Program | 519 Ladiga St Se, Jacksonville, AL 36265-2691 | 2020-08-14 |
| 1558970558 | Imran Ahmed Mridha | Student in an Organized Health Care Education/Training Program | 7932 Southside Blvd Apt 2409, Jacksonville, FL 32256-7958 | 2020-07-24 |
| 1750908588 | Irissel Rodriguez | Student in an Organized Health Care Education/Training Program | 2800 University Blvd S Apt 282, Jacksonville, FL 32216-2587 | 2020-06-27 |
| 1629692413 | Diana Piotrowski | Student in an Organized Health Care Education/Training Program | 100 Magnolia St Apt 6105, Jacksonville, FL 32204-2256 | 2020-06-08 |
| 1922622778 | Ryan D'armond Navarre | Student in an Organized Health Care Education/Training Program | 100 Magnolia St Apt 6213, Jacksonville, FL 32204-2257 | 2020-06-07 |
| 1063036937 | Karen Rebecca Clement | Student in an Organized Health Care Education/Training Program | 4929 Skyway Dr Apt 5212, Jacksonville, FL 32246-0047 | 2020-06-05 |
| 1134743107 | Christine Lalime | Student in an Organized Health Care Education/Training Program | 220 Riverside Ave Unit 203, Jacksonville, FL 32202-4947 | 2020-06-04 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32212 |
Please comment or provide details below to improve the information on SCOTT ANDREW WALLACE.
| 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.