Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Richard Edwin Waller, MD

Individual provider Family Medicine Physician · NPI 1821001041

Richard Edwin Waller, MD is a Family Practice in Marks, Mississippi. Graduated from University of Mississippi School of Medicine in 1974, 52 years ago. Practices with Delta Medical Foundation, an 8-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
52
Trained at
University of Mississippi School of Medicine
Licensed in
MS
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1024 Martin Luther King Dr
Marks, MS 38646-0289
Phone: (662) 326-3502
Fax: (662) 326-2555
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 07067 (MS)

Record details

NPI number1821001041
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 15, 2006
Last updated in NPPESMarch 1, 2017
Mailing addressPo Box 289, Marks, MS 38646-0289

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Graduated 1974 (52 years in practice)
Group practice Delta Medical Foundation — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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