Provider Demographics
NPI:1942731955
Name:WALLING, SAMUEL CLINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CLINTON
Last Name:WALLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:800 ROSE ST # C-246
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-6162
Mailing Address - Fax:859-257-8934
Practice Address - Street 1:4001 KRESGE WAY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-1995
Practice Address - Fax:502-928-3972
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY56880390200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program