DR. BRUCE DOUGLAS WALLEY (NPI# 1891771879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891771879 |
| Entity Type | Individual |
| Full Name | DR. BRUCE DOUGLAS WALLEY |
| Credential | MD |
| Practice Address |
4622 Country Club Rd Suite 180 Winston Salem NC 27104-3770 |
| Practice Telephone | 3367689535 |
| Practice Fax Number | 3367684155 |
| Mailing Telephone | 3367689535 |
| Mailing Fax Number | 3367684155 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2008-09-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 19421 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 8985520 | 05 |
| Street Address |
4622 COUNTRY CLUB RD SUITE 180 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27104-3770 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669097903 | Drs J Loveland and R Walker II, Pllc | Clinic/Center | 4622 Country Club Rd, Winston Salem, NC 27104-3769 | 2020-06-12 |
| 1649715525 | Jessica N Bonham | Physician Assistant | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3769 | 2016-12-30 |
| 1912373242 | Kyle Taylor Dds Pllc | Dentist | 4622 Country Club Rd, Ste. 280, Winston Salem, NC 27104-3769 | 2015-08-20 |
| 1427315878 | Novant Medical Group, Inc | Surgery | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3770 | 2012-04-23 |
| 1831402791 | Lindsay Scales Morgan | Physician Assistant | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3769 | 2010-07-21 |
| 1184828030 | Samuel Porter Jacks | Surgery | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3769 | 2007-06-13 |
| 1487868378 | Ronald William Logan Jr. | Dentist | 4622 Country Club Rd, Suite 240, Winston Salem, NC 27104 | 2007-05-09 |
| 1982790846 | Kyle W Taylor | Dentist | 4622 Country Club Rd, Suite 280, Winston Salem, NC 27104-3769 | 2006-10-05 |
| 1902909328 | Forsyth Cardiac & Vascular Surgeons, P.a. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3770 | 2006-09-07 |
| 1104802164 | Joel Clarence Morgan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3770 | 2005-12-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447807664 | Cameron Grant Ford | Psychologist | 614 Country Club Road, Winston-salem, NC 27104 | 2019-08-22 |
| 1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
| 1982100509 | Dillon James Magalski | Student in an Organized Health Care Education/Training Program | Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 | 2018-04-03 |
| 1891290144 | Breann M Poling | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 | 2018-03-28 |
| 1689178600 | Christopher Vasil | Student in an Organized Health Care Education/Training Program | Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 | 2018-03-23 |
| 1407379126 | April Lynn Lowe | Registered Nurse | 940 N Peace Haven Rd, Winstonsalem, NC 27104 | 2017-07-25 |
| 1164950804 | Donald Joyce | Student in an Organized Health Care Education/Training Program | 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 | 2017-05-25 |
| 1255867289 | Benjamin Hansen | Pharmacist | 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 | 2017-05-11 |
| 1770020976 | Jane Reed | Physical Medicine & Rehabilitation | 2627 E Greenbrier Road, Winston Salem, NC 27104 | 2017-01-25 |
| 1053728261 | Ashraf Alsaedi | Pharmacist | 1659 Stratford Rd Nw, Winston Salem, NC 27104 | 2014-07-20 |
| Find all providers in zip 27104 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619294345 | Peter John Smit | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Department of Cardiothoracic Surgery, Wake Forest Baptist Hospital Medical Center Boulevard, Winston Salem, NC 27157 | 2010-04-20 |
| 1326314808 | Robert Anthony Ferguson | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-9238 | 2012-03-28 |
| 1871769380 | Yoshio Otaki | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2008-05-05 |
| 1255514188 | Adrian L Lata | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2007-12-13 |
| 1902909328 | Forsyth Cardiac & Vascular Surgeons, P.a. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3770 | 2006-09-07 |
| 1174538672 | Ross M Ungerleider | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2006-07-31 |
| 1467495259 | Leonard James Wudel | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2006-06-13 |
| 1104802164 | Joel Clarence Morgan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4622 Country Club Rd, Suite 180, Winston Salem, NC 27104-3770 | 2005-12-21 |
| 1033193495 | John William Hammon | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-11-30 |
| 1285617985 | Edward Hal Kincaid | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-11-28 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.