Individual
STEPHEN C WALLER
Active
Individual
STEPHEN C WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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