Doctor Name: | MR. DAVID LOUIS WALLER |
NPI Number: | 1023242286 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | MA001013L |
Business Practice Address: | 60 Township Line Rd Elkins Park, PA - 190272220 |
Business Phone Number: | 2156636800 |
Business Fax Number: | 2156636547 |
Mailing Address: | 7435 Elizabeth Rd, ELKINS PARK |
State: | PA |
Postal Code: | 190273322 |
Phone Number: | 2157822223 |
Fax Number: | 2157821066 |
NPI Enumeration Date: | 05/03/2009 |
NPI Last Update Date: | 05/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | MA001013L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |