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BRYAN WALLACE MD
NPI 1417805722
Student in an Organized Health Care Education/Training Program in Largo, FL

Active since March 20, 2026
201 14TH ST SW, LARGO, FL 33770(727) 588-5680 Get Directions Write a Review

NPPES record last updated: March 20, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Bryan Wallace Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRYAN WALLACE MD (NPI 1417805722) is an individual student in an organized health care education/training program in Largo, Florida and active in the NPI registry since March 2026.

NPPES Registry Identity

NPI1417805722
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameBRYAN WALLACECredential: MD
Location Address201 14TH ST SWLargo, FL 33770-3133
Mailing Address201 14th St SwLargo, FL 33770-3133 · (727) 588-5680
Phone(727) 588-5680
Sole ProprietorYes
Enumeration DateMarch 20, 2026
NPPES CertifiedMarch 20, 2026
✔ NPI 1417805722 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
201 14TH ST SW, Largo, FL 33770
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RAOUL RUDOLPH BOTHA MD
Internal Medicine
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5704
HURARA KHAN
Student in an Organized Health Care Education/Training Program
201 14TH ST SW
LARGO, FL 33770
Pinellas County (813) 545-1090
SHIV BRIJ GAKHAR DO
Student in an Organized Health Care Education/Training Program
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5200
DR. GEORGE MIKHAIL MD
Student in an Organized Health Care Education/Training Program
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5680
MIRYAM MAKUTONIN DO
Student in an Organized Health Care Education/Training Program
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5680
DEBORAH JANAVS ARNP
Nurse Practitioner
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5222
SUHAIL KAYYALI
Internal Medicine (Gastroenterology)
201 14TH ST SW
LARGO, FL 33770
Pinellas County (305) 303-0317
SANDRA VIGO APRN
Nurse Practitioner (Family)
201 14TH ST SW
LARGO, FL 33770
Pinellas County (727) 588-5200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bryan Wallace's NPI number?

The NPI number for Bryan Wallace is 1417805722. It was assigned to this individual provider in the NPPES registry on March 20, 2026.

Where is Bryan Wallace located?

Bryan Wallace practices at 201 14th St SW, Largo, FL 33770. The listed phone number is (727) 588-5680.

What is Bryan Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Bryan Wallace was last updated on March 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.