| Dr William Chambers Waller Jr, MD | |
|
2805 5th St, 220, Rapid City, SD 57701-6003 | |
| (605) 348-1084 | |
| (605) 348-3256 |
| Full Name | Dr William Chambers Waller Jr |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 2805 5th St, Rapid City, South Dakota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528069515 | NPI | - | NPPES |
| 111265100 | Medicaid | WY | |
| 460350645 | Medicaid | NE | |
| 7500090 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | MD60933481 (Washington) | Secondary |
| 208800000X | Urology | 4033 (South Dakota) | Primary |
| Entity Name | Chadron Community Hospital Corp. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467675629 PECOS PAC ID: 0143397034 Enrollment ID: O20140710000370 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr William Chambers Waller Jr, MD 5171 Cub Lake Rd, Ste B280, Show Low, AZ 85901-7888 Ph: (928) 532-8663 | Dr William Chambers Waller Jr, MD 2805 5th St, 220, Rapid City, SD 57701-6003 Ph: (605) 348-1084 |
Keith G Bryson, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 2805 5th St, Suite 100, Rapid City, SD 57701 Phone: 605-719-5700 Fax: 605-719-5701 | |
Gerald W Butz, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 710 Saint Anne St, Rapid City, SD 57701 Phone: 605-348-4100 Fax: 605-348-0662 | |
Dr. Michael James Brekhus, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 2820 Mount Rushmore Rd, Rapid City, SD 57701 Phone: 605-342-3280 | |
Gary Christiansen, M.D. Urology Medicare: Medicare Enrolled Practice Location: 2820 Mount Rushmore Rd, Rapid City, SD 57701 Phone: 605-342-3280 Fax: 605-348-0662 |