Healthcare Provider Details

I. General information

NPI: 1447266234
Provider Name (Legal Business Name): CAROLYN M WALDO MD, FACEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 US HWY160
KAYENTA AZ
86033
US

IV. Provider business mailing address

3451 S MERCY RD STE 102
GILBERT AZ
85297-0206
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4000
  • Fax: 928-697-4083
Mailing address:
  • Phone: 866-817-5598
  • Fax: 855-307-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number10273
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13024-A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-25472
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2019-0186
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10325
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23218
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number103474
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10273
License Number StateSD
# 9
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65259
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46522
License Number StateIA
# 11
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10273
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: