Individual
DR. THOMAS A WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6300 W PARKER RD, SUITE 125, PLANO, TX 75093-8100
(469) 800-4400
(469) 800-4410
Mailing address
6300 W PARKER RD, SUITE 125, PLANO, TX 75093-8100
(469) 800-4400
(469) 800-4410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J2407
TX
207RC0000X
Cardiovascular Disease Physician
Primary
J2407
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118387304
—
TX
05
—
118387306
—
TX
05
—
118387307
—
TX
05
—
118387308
—
TX
01
—
8CX368
BCBSTX
TX
Enumeration date
06/28/2006
Last updated
09/18/2012
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