Dr. Jerold W Wallis
Nuclear Medicine Specialist
510 S Kingshighway Blvd Dept Radiology
Saint Louis
, Missouri 63110-1016
Dr. Jerold W Wallis
Nuclear Medicine Specialist
510 S Kingshighway Blvd Dept Radiology
Saint Louis
, Missouri 63110-1016
(314) 747-4189
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About
Features
Specialties
- Nuclear Medicine Specialist
Languages spoken
- English
Location
First Address
- Dr. Jerold W Wallis
- 660 S Euclid Ave Cb 8131
- Saint Louis, MO
- Zip : 63110-1010
- Fax : (314) 747-4189
- Phone : (314) 362-7200
Second Address
- Dr. Jerold W Wallis
- 510 S Kingshighway Blvd Dept Radiology
- Saint Louis, MO
- Zip : 63110-1016
- Fax : (314) 747-4189
- Phone : (314) 362-7200
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207U00000X | Nuclear Medicine Specialist | R9F90 | MO |
National Provider Identifier
| NPI | 1225122567 |
|---|---|
| Provider Name | Dr. Jerold W Wallis |
| First Address | Saint Louis, MO 63110-1010 |
| Second Address | Saint Louis, MO 63110-1016 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/10/2006 |
| Last Update Date | 15/11/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 209730209 | (05) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.