Healthcare Provider Details

I. General information

NPI: 1104894393
Provider Name (Legal Business Name): JAMES A WALER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 REGENCY SQUARE BLVD
JACKSONVILLE FL
32211-8119
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-855-1335
  • Fax: 904-724-6515
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME51750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: