Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1124005012 Deactivated / Inactive NPI Male Practitioner

Dr. Richard Gardner Wallis , MD

Anesthesiology • Jacksonville, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Richard Wallis has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 30, 2005
NPI Deactivation Date December 16, 2019
Total Practice Duration ~14 Years of Practice (2005 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Richard Wallis, MD was a registered Anesthesiology practicing in Jacksonville, FL. Throughout an active medical career spanning 14 years, Dr. Wallis provided care at the practice location at 6196 LAKE GRAY BLVD until profile deactivation on 2019-12-16.

Practice Location & Contact Primary Location

Practice Address

6196 Lake Gray Blvd
Suite 108

Jacksonville, FL 322447503

Telephone 9044212119
Associated Practice Facility / Clinic
🏢 Lake Gray Dialysis Center Llc Facility NPI 1588017784

Specialty Benchmarks & Practice Insights

Comparative analytics for Anesthesiology in Jacksonville, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 23.1 Yrs
State Avg: 27.3 Yrs
Regional Practice Density
274 Specialists

Practicing in Jacksonville, FL (3533 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Anesthesiology Primary Specialty

NUCC Taxonomy Code: 207L00000X

State License FL ME37752

An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
NPI 1013909860

Doctor of Medicine (M.D.)

Dr. Glen Martin , MD

Anesthesiology

NPI 1043202658

Doctor of Medicine (M.D.)

NPI 1043202666

Doctor of Medicine (M.D.)

Valerie Brink , LMHC

Counselor - Mental Health

NPI 1043321458

Licensed Mental Health Counselor

NPI 1063406742

Doctor of Medicine (M.D.)

Dr. Mark Zapp , MD

Anesthesiology

NPI 1083616577

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated December 16, 2019

Record deactivated on December 16, 2019

NPI Profile Active July 25, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 25, 2007

Registered at 6196 LAKE GRAY BLVD, SUITE 108, JACKSONVILLE, FL 322447503 (Tel: 9044212119)

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Updated Business Mailing Address July 25, 2007

Registered at PO BOX 863011, ORLANDO, FL 328863011

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Provider Name / Credentials Updated July 25, 2007

Recorded as RICHARD WALLIS, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 25, 2007

Anesthesiology (License #ME37752 in FL)

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Initial NPI Registration & Enumeration December 30, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1124005012
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 30, 2005
Last Update: July 25, 2007
Deactivation Date: December 16, 2019

Mailing Address

Po Box 863011

Orlando, FL 328863011

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.