Individual
DR. ROBERT RAY WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2500 S BROADWAY, BUILDING 200, EDMOND, OK 73013-4038
(405) 721-5145
Mailing address
8304 NW 113TH ST, OKLAHOMA CITY, OK 73162-2136
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
772
OK
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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