Benjamin R Waller III
Interventional Cardiology Pediatric Cardiologist
51 N Dunlap St Fl 2
Memphis
, Tennessee 38105
Benjamin R Waller III
Interventional Cardiology Pediatric Cardiologist
51 N Dunlap St Fl 2
Memphis
, Tennessee 38105
(901) 287-5594
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About
Features
Specialties
- Interventional Cardiology
- Pediatric Cardiologist
Languages spoken
- English
Location
First Address
- Benjamin R Waller III
- 848 Adams Ave
- Memphis, TN
- Zip : 38103-2816
- Phone : (901) 287-5594
Second Address
- Benjamin R Waller III
- 51 N Dunlap St Fl 2
- Memphis, TN
- Zip : 38105
- Fax : (901) 287-4646
- Phone : (901) 287-7337
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RI0011X | Interventional Cardiology | 19846 | TN |
| N | 2080P0202X | Pediatric Cardiologist | 19846 | TN |
National Provider Identifier
| NPI | 1013974062 |
|---|---|
| Provider Name | Benjamin R Waller III |
| First Address | Memphis, TN 38103-2816 |
| Second Address | Memphis, TN 38105 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 26/04/2006 |
| Last Update Date | 13/07/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 3086106 | (05) | TN |
| F89283 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.