Provider Demographics
NPI:1396841391
Name:WALLING, VERNON R II (MD, PA)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:R
Last Name:WALLING
Suffix:II
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4303
Mailing Address - Country:US
Mailing Address - Phone:713-582-0138
Mailing Address - Fax:
Practice Address - Street 1:5151 SAN FELIPE ST
Practice Address - Street 2:1470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3607
Practice Address - Country:US
Practice Address - Phone:713-622-4499
Practice Address - Fax:713-622-3466
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG02552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A90ZMedicare ID - Type Unspecified
TXC23128Medicare UPIN