Healthcare Provider Details

I. General information

NPI: 1962083527
Provider Name (Legal Business Name): STEPHEN BRIAN WALDEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP HUMPHREYS BLDG# 3030
APO AP
96271
US

IV. Provider business mailing address

PSC 307 BOX 1657
APO AP
96224-0017
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-3701
  • Fax:
Mailing address:
  • Phone: 315-737-3701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDOS-2383
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDOS-2383
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: