Healthcare Provider Details

I. General information

NPI: 1851366207
Provider Name (Legal Business Name): JAMES F WALERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIM WALERY NICKNAME

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/11/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 LAVELLE COURT
UNALASKA AK
99685
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-581-1202
  • Fax:
Mailing address:
  • Phone: 866-907-1068
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3967
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3967
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102832
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1636403
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier5609880
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: