Individual
WILLIAM LOWE WALLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 THOMPSON PARK, HATTIESBURG, MS 39401-8202
(601) 579-3130
(601) 264-5092
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-3130
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
21371
MS
207N00000X
Dermatology Physician
MD.201654
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05471708
—
MS
01
—
9789697
AETNA
MS
Enumeration date
11/20/2007
Last updated
08/03/2020
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