Bruce Douglas Walley, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

19421 Issued in NC

Practice address

4622 Country Club Rd
Suite 180
Winston Salem, NC 27104-3770

Phone

(336) 768-9535

Fax

(336) 768-4155

NPI assigned

Dec 21, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1891771879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 COUNTRY CLUB RD",
            "address_2": "SUITE 180",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043770",
            "telephone_number": "336-768-9535",
            "fax_number": "336-768-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 COUNTRY CLUB RD",
            "address_2": "SUITE 180",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043770",
            "telephone_number": "336-768-9535",
            "fax_number": "336-768-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEY",
        "first_name": "BRUCE",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NC",
            "license": "19421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8985520",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Mathew Wallace, CRNA
• Michelle Wallace
• Raven Wallace
• Kathryn Michele Wallen, CSAC
• Morgan Wallen, MD
• Margot Chantelle Wallin, CRNA
• Leigh Elizabeth Wallmeyer, M.S.
• Richard Ralph Walo Jr., DO
• Deanna Walser
• Bobbi Jo Walsh, NURSE

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.