Healthcare Provider Details

I. General information

NPI: 1205879475
Provider Name (Legal Business Name): OLIVER GREY WALDROP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5656
US

IV. Provider business mailing address

1510 E FLOWER ST
PHOENIX AZ
85014-5656
US

V. Phone/Fax

Practice location:
  • Phone: 602-530-6900
  • Fax:
Mailing address:
  • Phone: 602-530-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number18958
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number46900
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: