Individual
BENJAMIN R WALLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 N DUNLAP ST FL 2, MEMPHIS, TN 38105
(901) 287-7337
(901) 287-4646
Mailing address
848 ADAMS AVE, MEMPHIS, TN 38103-2816
(901) 287-5594
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
19846
TN
2080P0202X
Pediatric Cardiology Physician
19846
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3086106
—
TN
Enumeration date
04/26/2006
Last updated
07/13/2018
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