Individual
STEPHEN C WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3901 RAINBOW BOULEVARD, 6067 DELP, MAIL STOP 1028, KANSAS CITY, KS 66160
(913) 588-6035
(913) 945-6916
Mailing address
3901 RAINBOW BOULEVARD, 6067 DELP, MAIL STOP 1028, KANSAS CITY, KS 66160
(913) 588-6035
(913) 945-6916
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
04-30882
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200263690A
—
KS
05
—
205362312
—
MO
01
—
34056011
BCBS KC
MO
01
—
580860
FIRSTGUARD
KS
Enumeration date
09/06/2006
Last updated
05/08/2014
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