Individual
WAYNE WALLENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3095
(417) 875-3570
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
R1P10
MO
208VP0014X
Interventional Pain Medicine Physician
Primary
R1P10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710927132
—
MO
05
—
243003100
—
MO
01
—
P01382375
RR PTAN
MO
Enumeration date
06/07/2006
Last updated
12/27/2018
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