| Brian B Walls Md Pllc | |
|
500 Crockett Blvd Merritt Island FL 32953-5034 | |
| (321) 243-8593 | |
| (321) 454-2523 |
| Full Name | Brian B Walls Md Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 500 Crockett Blvd, Merritt Island, Florida |
| Authorized Official Name and Position | Brian B Walls (PHYSICIAN / OWNER) |
| Authorized Official Contact | 3212438593 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian B Walls Md Pllc Po Box 540033 Merritt Island FL 32954-0033 Ph: (321) 243-8593 | Brian B Walls Md Pllc 500 Crockett Blvd Merritt Island FL 32953-5034 Ph: (321) 243-8593 |
| NPI Number | 1891165023 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 05/22/2017 |
| Medicare PECOS PAC ID | 2567749468 |
|---|---|
| Medicare Enrollment ID | O20170502001432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891165023 | NPI | - | NPPES |
| 251358700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME71812 (Florida) | Primary |
| Provider Name | Brian Bolivar Walls |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508866237 PECOS PAC ID: 5698805331 Enrollment ID: I20100607000890 |
| Provider Name | Lisa Ann Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467932525 PECOS PAC ID: 9537594932 Enrollment ID: I20200113001524 |
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