William Chambers Waller Jr., M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

4033 Issued in SD

Practice address

2805 5TH St
220
Rapid City, SD 57701-6003

Phone

(605) 348-1084

Fax

(605) 348-3256

NPI assigned

Aug 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Urological Clinic of Rapid City, P.C.

  • Urology Physician
  • Rapid City, SD
  • NPI 1578672705
  NPD (past)
• Regional West Physicians Clinic

  • Rural Health Clinic/Center
  • Mitchell, NE
  • NPI 1992703425
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1528069515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 CUB LAKE RD",
            "address_2": "STE B280",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017888",
            "telephone_number": "928-532-8663",
            "fax_number": "928-532-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 5TH ST",
            "address_2": "220",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016003",
            "telephone_number": "605-348-1084",
            "fax_number": "605-348-3256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Goethals Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "993523301",
            "country_code": "US",
            "telephone_number": "509-942-3165",
            "fax_number": "509-942-3167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "WILLIAM",
        "middle_name": "CHAMBERS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD60933481",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SD",
            "license": "4033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111265100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460350645",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7500090",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #09512)
• Walgreen Co (Walgreens #05643)
• Walking in Grace Inc.
• Jennifer Louise Wallace, CSW, QMHP
• Kimberly Anne Wallace
• Walmart Inc. (Walmart Pharmacy 10-1604)
• Walmart Inc. (WalMart Pharmacy 10-3872)
• Walmart Inc. (Walmart Vision Center 30-1604)
• Scott Walther, HIS
• Crystal L Walton, PA C CNP

• Urology Physician in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Urology Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; 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.