# ROBERT C WALLER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1326097809
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | 4301087247 | MI | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | 4301087247 | MI | Yes |

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 11/14/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | P00343656 | RAILROAD MEDICARE | MI |