Individual
JAMES L WALLER V
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
709 SPRING VALLEY RD, BURLINGTON, WI 53105-7614
(262) 767-6020
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(262) 767-6020
(262) 767-6023
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4760
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091606
—
WI
Enumeration date
06/13/2019
Last updated
06/10/2022
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