Individual
BLAISE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1801 HICKMAN RD, DES MOINES, IA 50314-1597
(515) 282-5640
(515) 282-2332
Mailing address
1801 HICKMAN RD, DES MOINES, IA 50314-1597
(515) 282-5640
(515) 282-2332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R-12276
IA
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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