Charles Waller, MD

NPI #1306841341 in Benton, Kentucky

Provider Information

NPI Number: 1306841341
Entity Type: Individual
Name: Charles Waller, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: General Practice
Credential: MD
Enumeration Date: Jun 16, 2005
Last Updated: Feb 1, 2017

Practice Location

Address: 218 BASS LN
City: Benton
State: Kentucky
ZIP Code: 42025-5824
Phone: (270) 556-3239

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary
Emergency Medicine	207P00000X

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