IndividualActive
Charles Waller, MD
NPI 1306841341 · General Practice Physician · Benton, KY
Provider details
- NPI number
- 1306841341
- Entity type
- Individual
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 29738 (KY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
218 Bass Ln
Benton, KY 42025-5824
Phone: (270) 556-3239
Fax: (270) 354-5865
Approximate (ZIP-level) locationGet directions
Mailing address
218 Bass Ln
Benton, KY 42025-5824
Registry dates
- Enumerated
- 2005-06-16
- Last updated
- 2017-02-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.