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NPI Code Detail

MEDICARE: ROBERT C WALLER MD

MEDICARE: ROBERT C WALLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PE0004XEmergency Medical Services (Emergency Medicine) Physician4301087247MI
2207RA0401XAddiction Medicine (Internal Medicine) Physician4301087247MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00343656OTHERMIRAILROAD MEDICARE

General Provider Information

NPI Number : 1326097809
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT C WALLER MD
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 513-873-1269
Fax Number :
Provider Business Practice Location Address
First Line : 446 MORGAN ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45206-2348
Country : US
Telephone Number : 833-510-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 11/14/2024

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