Provider Demographics
NPI:1316288814
Name:WALLING, JAMES (RPA/RA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WALLING
Suffix:
Gender:M
Credentials:RPA/RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2204
Mailing Address - Country:US
Mailing Address - Phone:435-259-4633
Mailing Address - Fax:
Practice Address - Street 1:450 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2065
Practice Address - Country:US
Practice Address - Phone:435-719-3693
Practice Address - Fax:435-719-3694
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant