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  5. WALTER D. DEVAULT,III M.D.P.A.

WALTER D. DEVAULT,III M.D.P.A.

Company Details

Entity Name: WALTER D. DEVAULT,III M.D.P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 18 Aug 2005 (19 years ago)
Document Number: P05000115615
FEI/EIN Number 203367986
Address: 816 EAST OCEAN BLVD., STUART, FL, 34994
Mail Address: 816 EAST OCEAN BLVD., STUART, FL, 34994
ZIP code: 34994
County: Martin
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1023299609 2007-11-23 2007-11-26 816 SE OCEAN BLVD, STUART, FL, 349942428, US 816 SE OCEAN BLVD, STUART, FL, 349942428, US

Contacts
Phone +1 772-286-5551
Fax 7722863026

Authorized person
Name DR. WALTER D DEVAULT III
Role OWNER
Phone 7722865551

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME79492
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS
Number 35751
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2018 203367986 2019-08-14 WALTER D. DEVAULT, III, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2019-08-14
Name of individual signing WALTER DEVAULT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-08-14
Name of individual signing WALTER DEVAULT
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2017 203367986 2018-10-09 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-09
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2016 203367986 2017-10-11 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-11
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2015 203367986 2016-10-13 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2016-10-13
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-13
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2014 203367986 2015-10-08 WALTER D. DEVAULT, III, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2015-10-08
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-08
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2013 203367986 2014-08-29 WALTER D. DEVAULT, III, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2014-08-29
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-29
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2012 203367986 2013-10-11 WALTER D. DEVAULT, III, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-11
Name of individual signing WALTER D DEVAULT III
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2011 203367986 2012-10-11 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Plan administrator’s name and address
Administrator’s EIN 203367986
Plan administrator’s name WALTER D. DEVAULT, III, M.D., P.A.
Plan administrator’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994
Administrator’s telephone number 7722865551

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing WALTER D DEVAULT III MD PA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing WALTER D DEVAULT III MD PA
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2010 203367986 2011-10-12 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Plan administrator’s name and address
Administrator’s EIN 203367986
Plan administrator’s name WALTER D. DEVAULT, III, M.D., P.A.
Plan administrator’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994
Administrator’s telephone number 7722865551

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing WALTER DEVAULT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-12
Name of individual signing WALTER DEVAULT
Valid signature Filed with authorized/valid electronic signature
WALTER D. DEVAULT, III, M.D., P.A., 401(K) PROFIT SHARING PLAN 2009 203367986 2010-10-11 WALTER D. DEVAULT, III, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 7722865551
Plan sponsor’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994

Plan administrator’s name and address
Administrator’s EIN 203367986
Plan administrator’s name WALTER D. DEVAULT, III, M.D., P.A.
Plan administrator’s address 816 EAST OCEAN BOULEVARD, STUART, FL, 34994
Administrator’s telephone number 7722865551

Signature of
Role Plan administrator
Date 2010-10-11
Name of individual signing WALTER D DEVAULT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-11
Name of individual signing WALTER D DEVAULT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FIELDS JORDAN Agent 416 SE CORTEZ AVE, STUART, FL, 34994

President

Name Role Address
DEVAULT WALTER D President 816 EAST OCEAN BLVD., STUART, FL, 34994

Documents

Name Date
ANNUAL REPORT 2024-04-25
ANNUAL REPORT 2023-04-25
ANNUAL REPORT 2022-04-17
ANNUAL REPORT 2021-04-25
ANNUAL REPORT 2020-06-21
ANNUAL REPORT 2019-04-28
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-04-22
ANNUAL REPORT 2016-04-21
ANNUAL REPORT 2015-04-18

Related by officers

DEVAULT WALTER D

DEVAULT PROPERTIES OF STUART, LLC

FIELDS JORDAN

BILL HEBSON MULTI SPORTS MANAGEMENT AND MEDIA, INC. 21/20 TILE LLC 100% MANAGEMENT, LLC 192 COMMERCIAL PLAZA ,LLC 416 CORTEZ BUILDING CORPORATION JORDAN FIELDS, P.A. PJV PROPERTIES LLC INFINITY ASSET GROUP, INC. FIRST LANDMARK REALTY VENTURES, INC. PINNACLE GROUP RECRUITERS, INC.

Related by address

816 EAST OCEAN BLVD., STUART, FL, 34994

DEVAULT PROPERTIES OF STUART, LLC DAVID ELLIOTT BRIGHT, M.D., PROFESSIONAL ASSOCIATION

816 EAST OCEAN BLVD., STUART, FL, 34994

DEVAULT PROPERTIES OF STUART, LLC DAVID ELLIOTT BRIGHT, M.D., PROFESSIONAL ASSOCIATION

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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