Individual
LARRY HENLE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S UNIVERSITY AVE, SUITE 316, LITTLE ROCK, AR 72205-5302
(501) 603-9600
(501) 603-0042
Mailing address
500 S UNIVERSITY AVE, SUITE 316, LITTLE ROCK, AR 72205-5302
(501) 603-9600
(501) 603-0042
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E0253
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04828
HEALTHSOURCE
—
05
—
125849001
—
AR
05
—
137315002
—
AR
01
—
16047000000
QUALCHOICE
—
01
—
71082800072205AO
TRICARE WPS
—
01
—
7420056
UNITED HEALTHCARE
—
Enumeration date
08/05/2006
Last updated
07/09/2007
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