# LARRY HENLE WALLER

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

## Provider details

- **NPI number:** 1710996996
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | E0253 | AR | Yes |

## Other

- **Enumeration date:** 08/05/2006
- **Last updated:** 07/09/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 04828 | HEALTHSOURCE | — |
| 05 | — | 125849001 | — | AR |
| 05 | — | 137315002 | — | AR |
| 01 | — | 16047000000 | QUALCHOICE | — |
| 01 | — | 71082800072205AO | TRICARE WPS | — |
| 01 | — | 7420056 | UNITED HEALTHCARE | — |