William Lowe Waller III
Dermatologist
3 Thompson Park
Hattiesburg
, Mississippi 39401-8202
William Lowe Waller III
Dermatologist
3 Thompson Park
Hattiesburg
, Mississippi 39401-8202
(601) 579-5240
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- William Lowe Waller III
- 415 S 28th Ave
- Hattiesburg, MS
- Zip : 39401-7246
- Fax : (601) 579-5240
- Phone : (601) 579-3130
Second Address
- William Lowe Waller III
- 3 Thompson Park
- Hattiesburg, MS
- Zip : 39401-8202
- Fax : (601) 264-5092
- Phone : (601) 579-3130
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 21371 | MS |
| N | 207N00000X | Dermatologist | MD.201654 | LA |
National Provider Identifier
| NPI | 1053592840 |
|---|---|
| Provider Name | William Lowe Waller III |
| First Address | Hattiesburg, MS 39401-7246 |
| Second Address | Hattiesburg, MS 39401-8202 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/11/2007 |
| Last Update Date | 03/08/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 05471708 | (05) | MS |
| 9789697 | AETNA (01) | MS |
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.