Individual
DR. WILLIAM CHAMBERS WALLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2805 5TH ST, 220, RAPID CITY, SD 57701-6003
(605) 348-1084
(605) 348-3256
Mailing address
5171 CUB LAKE RD, STE B280, SHOW LOW, AZ 85901-7888
(928) 532-8663
(928) 532-8665
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4033
SD
208800000X
Urology Physician
MD60933481
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111265100
—
WY
05
—
460350645
—
NE
05
—
7500090
—
SD
Enumeration date
08/02/2005
Last updated
02/27/2019
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