Individual
JASON WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2301 S LAMAR BLVD, OXFORD, MS 38655-5373
(800) 291-4020
(919) 419-7247
Mailing address
3211 SHANNON RD, SUITE 300, DURHAM, NC 27707-6322
(800) 291-4020
(919) 419-7247
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16730
MS
Other
Enumeration date
05/19/2006
Last updated
08/01/2007
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