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Individual
JONATHAN WALLER
Active
Individual
JONATHAN WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD/MPH
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
198799
OR
207R00000X
Internal Medicine Physician
A167405
CA
208M00000X
Hospitalist Physician
198799
OR
208M00000X
Hospitalist Physician
Primary
A167405
CA
Other
Enumeration date
05/30/2017
Last updated
03/22/2024
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