Wallis, Jerold W
Wallis, Jerold W is an individual health care provider with primary practice located at 510 S Kingshighway Blvd Dept Radiology, Saint Louis MO 63110-1016. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nuclear Medicine, which is considered as his primary health care specialty. Wallis, Jerold W can be contacted via phone (314) 362-7200.Contact Information
Primary practice address
510 S Kingshighway Blvd Dept Radiology
Saint Louis MO 63110-1016
Phone: (314) 362-7200
Fax: (314) 747-4189
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nuclear Medicine | 207U00000X | R9F90 | Missouri |
Profile Details
| NPI number | 1225122567 |
|---|---|
| LBN Legal business name | Wallis, Jerold W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 3rd, 2006 |
| Last updated | Apr 25th, 2024 - about 7 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225122567 | NPPES |
| Missouri | MEDICAID | 209730209 |
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