Active NPI
Larry Henle Waller, M.D.
- Obstetrics & Gynecology Physician
- Little Rock, AR
National Provider Identifier
1710996996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- E0253
- Practice address
- 500 S University Ave
Suite 316
Little Rock, AR 72205-5302 - Phone
- (501) 603-9600
- Fax
- (501) 603-0042
- NPI assigned
- Aug 5, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | E0253 | AR | Primary |
Addresses
Primary practice location
500 S University Ave
Suite 316
Little Rock, AR 72205-5302
Mailing address
500 S University Ave
Suite 316
Little Rock, AR 72205-5302
Phone (501) 603-9600
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 137315002 | Medicaid | AR | |
| 125849001 | Medicaid | AR | |
| 71082800072205AO | Other | TRICARE WPS | |
| 04828 | Other | HEALTHSOURCE | |
| 16047000000 | Other | QUALCHOICE | |
| 7420056 | Other | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E0253 | AR | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1710996996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 S UNIVERSITY AVE",
"address_2": "SUITE 316",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055302",
"telephone_number": "501-603-9600",
"fax_number": "501-603-0042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S UNIVERSITY AVE",
"address_2": "SUITE 316",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722055302",
"telephone_number": "501-603-9600",
"fax_number": "501-603-0042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "LARRY",
"middle_name": "HENLE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "AR",
"license": "E0253",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "137315002",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "125849001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WPS",
"identifier": "71082800072205AO",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSOURCE",
"identifier": "04828",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "16047000000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "7420056",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.