Individual
DR. BRUCE DOUGLAS WALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4622 COUNTRY CLUB RD, SUITE 180, WINSTON SALEM, NC 27104-3770
(336) 768-9535
(336) 768-4155
Mailing address
4622 COUNTRY CLUB RD, SUITE 180, WINSTON SALEM, NC 27104-3770
(336) 768-9535
(336) 768-4155
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
19421
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8985520
—
NC
Enumeration date
12/21/2005
Last updated
09/11/2008
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