DR. PAUL R. WALLACE (NPI# 1306875869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306875869 |
| Entity Type | Individual |
| Full Name | DR. PAUL R. WALLACE |
| Credential | M.D. |
| Practice Address |
1301 2nd Ave Sw Largo FL 33770-3120 |
| Practice Telephone | 7275847706 |
| Practice Fax Number | 7275813727 |
| Mailing Telephone | 7275847706 |
| Mailing Fax Number | 7275813727 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2011-02-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | ME69904 | FL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629054598 | Paul Wayne Wallace | Pharmacist | 315 Mlk Way, Tacoma, WA 98405 | 2005-12-21 |
| 1265991335 | Paul Michael Wallace | Psychiatry & Neurology | 401 Parnassus Ave, San Francisco, CA 94143-0984 | 2019-03-18 |
| 1669794764 | Paul John Wallace | Pharmacist | 1993 Dickerson Blvd, Monroe, NC 28110-2795 | 2010-02-17 |
| 1548444318 | Paul S Wallace | Licensed Practical Nurse | 513 Se Quapaw, Bartlesville, OK 74003 | 2007-12-28 |
| 1114044799 | Paul David Wallace | Licensed Psychiatric Technician | 1212 N California St, Stockton, CA 95202-1552 | 2007-03-26 |
| 1770649741 | Paul D Wallace | Dentist | 8305 Walnut Hill Ln, Suite 235, Dallas, TX 75231-4217 | 2006-12-27 |
| 1639287212 | Paul Wallace | Internal Medicine | 3400 Spruce St, 5 Maloney, Philadelphia, PA 19104-4238 | 2006-08-25 |
| 1063494474 | Paul Wesley Wallace | Dermatology | 8920 Wilshire Blvd, Suite 327, Beverly Hills, CA 90211-2007 | 2005-11-19 |
| Street Address |
1301 2ND AVE SW |
| City | LARGO |
| State | FL |
| Zip Code | 33770-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407851314 | Diagnostic Clinic Medical Group Inc. | Allergy & Immunology | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2005-06-16 |
| 1952924979 | Jordan Ashley Bennett | Advanced Practice Midwife | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2020-05-26 |
| 1205477072 | Calli Keenan Fodor | Audiologist | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2019-10-03 |
| 1093283145 | Patricia Hanratty | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2018-11-07 |
| 1649786781 | Erica Anne Martin | Physician Assistant | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2017-12-27 |
| 1144736927 | Mladen Nikolic | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770 | 2017-12-15 |
| 1922524958 | Kimmy Nhut Nguyen | Physician Assistant | 1301 2nd Ave Sw, Largo, FL 33770 | 2017-08-22 |
| 1164959920 | Orthopaedic Associates of West Florida, Pa | Clinic/Center | 1301 2nd Ave Sw, Fl 6, Largo, FL 33770-3120 | 2017-05-11 |
| 1932644580 | Janet A Mccormick | Nurse Practitioner | 1301 2nd Ave Sw, Largo, FL 33770-2298 | 2017-01-05 |
| 1619323417 | Optic Shoppe Dme | Durable Medical Equipment & Medical Supplies | 1301 2nd Ave Sw, Largo, FL 33770-3120 | 2016-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467005041 | Chelsey Lyn Shepos | Optometrist | 1030 West Bay Dr, Suite 200, Largo, FL 33770 | 2019-07-22 |
| 1407353626 | Michael E Ibrahim | Pharmacist | 1290 West Bay Drive, Largo, FL 33770 | 2018-04-13 |
| 1518413384 | Payton Kuhlenbeck | Anesthesiology | 210 14th Street Sw, Largo, FL 33770 | 2016-08-31 |
| 1639536865 | Ryan Boice | Physical Therapy Assistant | 118 West Bay Drive, Suite 111, Largo, FL 33770 | 2016-01-19 |
| 1508238858 | Alignment Healthcare Florida LLC | Clinic/Center | 1301 2nd Ave., Sw, Largo, FL 33770 | 2015-10-27 |
| 1891161808 | Jessica Nicole Mcglone | Nurse Practitioner | 601 Rosery Rd Ne Apt 1502, Largo, FL 33770 | 2015-08-12 |
| 1033598602 | Demetria Anderson | Counselor | 1301 Seminole Blvd Ste 103, Largo, FL 33770 | 2015-05-28 |
| 1962881821 | Building Blocks Therapy, Pllc | Community/Behavioral Health | 1301 Seminole Blvd Building A Suite 103, Largo, FL 33770 | 2015-05-26 |
| 1457765968 | Summer Moon | Dermatology | 115 Highland Ave N, Largo, FL 33770 | 2014-06-12 |
| 1578982393 | Lauren Elizabeth Grandpre | Emergency Medicine | 201 14th St. Sw, Largo Medical Center Emergency Department, Largo, FL 33770 | 2014-04-09 |
| Find all providers in zip 33770 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902112923 | Christie Youssef | Family Medicine | 2025 Indian Rocks Rd., Largo, FL 33774 | 2010-08-27 |
| 1588998488 | Village Family Practice | Family Medicine | 8250 Bryan Dairy Rd Ste 300, Largo, FL 33777-1356 | 2009-09-24 |
| 1255569943 | Zozan Al Saadi | Family Medicine | 7050 Ulmerton Rd, Largo, FL 33771 | 2009-07-01 |
| 1063665867 | East Bay Family Practice LLC | Family Medicine | 3387 3391 Easy Bay Drive, Largo, FL 33771 | 2008-10-24 |
| 1841470952 | Gabriel A Decandido Pa | Family Medicine | 8005 Ulmerton Rd, Largo, FL 33771-3971 | 2007-11-06 |
| 1255530382 | Jaimie Louise Mickey | Family Medicine | 13117 66th St, Largo, FL 33773-1812 | 2007-07-18 |
| 1881801140 | Moneer M. Mansour,md.pa | Family Medicine | 8787 Bryan Dairy Rd Ste 330, Largo, FL 33777-1260 | 2007-05-17 |
| 1194858969 | Snyder Family Medicine Pa | Family Medicine | 1042 Belcher Rd S, Largo, FL 33771-3316 | 2007-03-13 |
| 1801926001 | Kirsten Lea Cooper | Family Medicine | 13220 Starkey Rd Ste 500, Largo, FL 33773-1446 | 2007-03-06 |
| 1467515221 | Sun Coast Hospital Inc | Family Medicine | 1559 Indian Rocks Rd S, Largo, FL 33770-4542 | 2006-12-19 |
| Find all providers in LARGO | ||||
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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.