Wallace, Robert Jennings

Wallace, Robert Jennings is an sole proprietor health care provider with primary practice located at 3600 Central Ave , St Petersburg FL 33711-1345. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Medicine, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Wallace, Robert Jennings can be contacted via phone (727) 826-0700.

Contact Information

Primary practice address
3600 Central Ave St Petersburg FL 33711-1345
Phone: (727) 826-0700
Fax: (727) 954-6994
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X ME 42522 Florida
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME42522 Florida
Allopathic & Osteopathic Physicians / General Practice 208D00000X ME42522 Florida

Profile Details

NPI number 1821396151
LBN Legal business name Wallace, Robert Jennings
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 10th, 2011
Last updated Dec 28th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821396151 NPPES
Florida Other 1108108 STAYWELL
Florida Other 0007618489 STAYWELL
Florida Other 14NU6 STAYWELL
Florida Other 11382461 STAYWELL
Florida Other 189052 STAYWELL
Florida Other 000121140 STAYWELL
Florida Other 05595987 STAYWELL
Florida Other 14NU6 STAYWELL
Florida MEDICAID 111163300 STAYWELL
Florida Other 14NU6 STAYWELL

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