Waller, James D

Waller, James D is an individual health care provider with primary practice located at 950 S Kenmore Dr Ste B , Evansville IN 47714-7513. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Waller, James D can be contacted via phone (812) 301-8110.

Contact Information

Primary practice address
950 S Kenmore Dr Ste B Evansville IN 47714-7513
Phone: (812) 301-8110
Fax: (812) 401-4001
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 01029847A Indiana

Profile Details

NPI number 1366440299
LBN Legal business name Waller, James D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2005
Last updated Apr 15th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366440299 NPPES
Indiana Other 01029847A STATE LICENSE
Indiana Other 000000042443 STATE LICENSE
Indiana MEDICAID 100352100 STATE LICENSE
Indiana MEDICAID 64757446 STATE LICENSE

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