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B. JEFFREY WALLIS, M.D., P.A. - Florida Company Profile

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Company Details

Entity Name: B. JEFFREY WALLIS, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 22 Jun 2011 (14 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 13 Oct 2017 (8 years ago)
Document Number: P11000057995
FEI/EIN Number 452651123
Address: 6152 W CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL, 34429
Mail Address: 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429
ZIP code: 34429
City: Crystal River
County: Citrus
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
WALLIS B. JEFFREY Director 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429
WALLIS B. JEFFREY Secretary 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429
WALLIS B. JEFFREY Agent 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429
WALLIS B. JEFFREY President 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429
WALLIS B. JEFFREY Treasurer 6752 W GULF TO LAKE HWY #101, CRYSTAL RIVER, FL, 34429

National Provider Identifier

NPI Number:
1003199076

Authorized Person:

Name:
DR. BARRETT JEFFREY WALLIS
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207RG0100X - Gastroenterology Physician
Is Primary:
Yes

Contacts:

Fax:
3525643906
Fax:
3525643903

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000106836 ADVANCED GASTROENTEROLOGY EXPIRED 2011-11-01 2016-12-31 - 6152 W. CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL, 34429
G11000096160 ADVANCED GASTROENTEROLOGY ASSOCIATES ACTIVE 2011-09-29 2026-12-31 - 6152 W. CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL, 34429

Events

Event Type Filed Date Value Description
REINSTATEMENT 2017-10-13 - -
REGISTERED AGENT NAME CHANGED 2017-10-13 WALLIS, B. JEFFREY -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2017-09-22 - -
REINSTATEMENT 2013-12-02 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2013-09-27 - -
CHANGE OF PRINCIPAL ADDRESS 2012-04-28 6152 W CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL 34429 -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J18000072181 LAPSED 8:16-CV-3094-T-30MAP USDC MIDDLE DISTRICT OF FLORID 2017-06-22 2023-02-21 $60,510.00 DAN BARAJAS, 2807 LETHER FERN DRIVE, OCOEE FL 34761

Documents

Name Date
ANNUAL REPORT 2024-04-23
ANNUAL REPORT 2023-04-25
ANNUAL REPORT 2022-03-22
ANNUAL REPORT 2021-06-22
ANNUAL REPORT 2020-06-02
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-04-18
REINSTATEMENT 2017-10-13
ANNUAL REPORT 2016-04-30
ANNUAL REPORT 2015-04-21

USAspending Awards / Financial Assistance

Date:
2020-06-24
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
87500.00
Total Face Value Of Loan:
87500.00
Date:
2020-04-30
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
54000.00
Total Face Value Of Loan:
54000.00

Paycheck Protection Program

Jobs Reported:
11
Initial Approval Amount:
$54,000
Date Approved:
2020-04-30
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$54,000
Race:
American Indian or Alaska Native
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$54,365.42
Servicing Lender:
Regions Bank
Use of Proceeds:
Payroll: $54,000
Jobs Reported:
11
Initial Approval Amount:
$39,910
Date Approved:
2021-01-25
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$39,910
Race:
American Indian or Alaska Native
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$40,229.28
Servicing Lender:
Regions Bank
Use of Proceeds:
Payroll: $39,909
Utilities: $1

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Date of last update: 02 Aug 2025

Sources: Florida Department of State