Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Bryan Wallace, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1417805722

Bryan Wallace, MD is a Student in an Organized Health Care Education/Training Program in Largo, Florida. Practices as a sole proprietor. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

201 14th St SW
Largo, FL 33770-3133
Phone: (727) 588-5680
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1417805722
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 20, 2026
Last updated in NPPESMarch 20, 2026
Certification dateMarch 20, 2026
Mailing address201 14th St Sw, Largo, FL 33770-3133

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