Individual
ROBERT WALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5650
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5650
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
30801
MS
207RP1001X
Pulmonary Disease Physician
S8672
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1J2146
MEDICARE
TX
05
—
417472401
—
TX
Enumeration date
07/08/2015
Last updated
01/05/2023
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