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

Max Joseph Wallack

Individual provider Diagnostic Radiology Physician · NPI 1043839814

Max Joseph Wallack is a Diagnostic Radiology in Jacksonville, Florida. Qualified in 2020, 6 years ago. Practices with St Josephs Diagnostic Center LLC, a 90-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
6
Licensed in
FL
In the registry since
2020
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Practice location Address checks out

655 W 8th St
Jacksonville, FL 32209-6511
Phone: (774) 270-0554
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence ME176656 (FL)

Record details

NPI number1043839814
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 13, 2020
Last updated in NPPESOctober 30, 2025
Certification dateOctober 30, 2025
Mailing address3580 Pall Mall Dr Apt 2604, Jacksonville, FL 32257-5486

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice St Josephs Diagnostic Center Llc — 90 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations11 on file with Medicare

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