Individual
WALLER LISLE DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 ROSE STREET, LEXINGTON, KY 40536-0001
(859) 323-5345
Mailing address
138 LEADER AVE, LEXINGTON, KY 40508-3215
(859) 257-7910
(859) 257-7899
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
18542
KY
207VX0000X
Obstetrics Physician
18542
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64185424
—
KY
Enumeration date
07/14/2006
Last updated
03/19/2012
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