Waller Medical Clinic, P.a.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

F2902 Issued in TX

Legal business name

WALLER MEDICAL CLINIC, P.A.

Practice address

11301 Fallbrook Dr
Ste 101
Houston, TX 77065-4237

Phone

(281) 890-9146

Fax

(281) 894-1115

NPI assigned

Mar 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pon Satitpunwaycha, M.D., F.A.C.S.

Title

Doctor

Phone

(281) 890-9146

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1518091925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11301 FALLBROOK DR",
            "address_2": "STE 101",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770654237",
            "telephone_number": "281-890-9146",
            "fax_number": "281-894-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 FALLBROOK DR",
            "address_2": "STE 101",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770654237",
            "telephone_number": "281-890-9146",
            "fax_number": "281-894-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLER MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SATITPUNWAYCHA",
        "authorized_official_first_name": "PON",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "281-890-9146",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., F.A.C.S."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": "F2902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shernique Wallace, DDS
• Sowdhamini Shettigar Wallace, D.O.
• Stephanie Wallace, MS, CGC
• Rebecca Burditt Walle, RN
• Wayne Wallen, D.C
• John Christopher Waller-Delarosa, M.D.
• Gaytha Waller
• Julie Waller
• Kandie A Waller, NP-C
• Lisa Ann Waller, RPH

• Surgery Physician in Houston, TX
• Providers in Houston, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.