Healthcare Provider Details

I. General information

NPI: 1861499832
Provider Name (Legal Business Name): JOHN P WALDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 US HIGHWAY 43
WINFIELD AL
35594-5056
US

IV. Provider business mailing address

2000A SOUTHBRIDGE PKWY STE 300
BIRMINGHAM AL
35209-7718
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-0123
  • Fax:
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19892
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: