Individual
DAVID F WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4868 BRIDGE RD, SUITE 300, SUFFOLK, VA 23435-2048
(757) 483-7100
(757) 483-7150
Mailing address
4868 BRIDGE RD, SUITE 300, SUFFOLK, VA 23435-2048
(757) 483-7100
(757) 483-7150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101047125
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005623260
—
VA
Enumeration date
07/20/2005
Last updated
07/22/2013
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