Mervin P Wallace
Family Doctor Family Doctor - Geriatric Medicine
1803 Miccosukee Commons Dr Suite 202
Tallahassee
, Florida 32308-7403
Mervin P Wallace
Family Doctor Family Doctor - Geriatric Medicine
1803 Miccosukee Commons Dr Suite 202
Tallahassee
, Florida 32308-7403
(850) 297-2020
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About
Features
Specialties
- Family Doctor
- Family Doctor - Geriatric Medicine
Languages spoken
- English
Location
First Address
- Mervin P Wallace
- Po Box 12427
- Tallahassee, FL
- Zip : 32317-2427
- Fax : (850) 297-2020
- Phone : (850) 297-0114
Second Address
- Mervin P Wallace
- 1803 Miccosukee Commons Dr Suite 202
- Tallahassee, FL
- Zip : 32308-7403
- Fax : (850) 325-6017
- Phone : (850) 402-6205
Reviews
FAQs
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Is Mervin P Wallace a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Q00000X | Family Doctor | ME95779 | FL |
| N | 207QG0300X | Family Doctor - Geriatric Medicine | ME95779 | FL |
National Provider Identifier
| NPI | 1346269883 |
|---|---|
| Provider Name | Mervin P Wallace |
| First Address | Tallahassee, FL 32317-2427 |
| Second Address | Tallahassee, FL 32308-7403 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/07/2006 |
| Last Update Date | 30/10/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 276781300 | (05) | FL |
| CN3432 | GROUP MEDICARE RR (01) | FL |
| I65765 | (02) | FL |
| P00964768 | MEDICARE RR (01) | FL |
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.