Individual
DR. JAMES D WALLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
950 S KENMORE DR STE B, EVANSVILLE, IN 47714-7513
(812) 301-8110
(812) 401-4001
Mailing address
950 S KENMORE DR STE B, EVANSVILLE, IN 47714-7513
(812) 301-8110
(812) 401-4001
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
01029847A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042443
ANTHEM BC/BS
IN
01
—
01029847A
STATE LICENSE
IN
05
—
100352100
—
IN
05
—
64757446
—
KY
Enumeration date
07/13/2005
Last updated
04/15/2019
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