Walley, Bruce Douglas
Walley, Bruce Douglas is an individual health care provider with primary practice located at 4622 Country Club Rd Suite 180, Winston Salem NC 27104-3770. He recently has only one registered license in Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), which is considered as his primary health care specialty. Walley, Bruce Douglas can be contacted via phone (336) 768-9535.Contact Information
Primary practice address
4622 Country Club Rd Suite 180
Winston Salem NC 27104-3770
Phone: (336) 768-9535
Fax: (336) 768-4155
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 19421 | North Carolina |
Profile Details
| NPI number | 1891771879 |
|---|---|
| LBN Legal business name | Walley, Bruce Douglas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 21st, 2005 |
| Last updated | Sep 11th, 2008 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891771879 | NPPES |
| North Carolina | MEDICAID | 8985520 |
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