Healthcare Provider Details

I. General information

NPI: 1730120197
Provider Name (Legal Business Name): ANNE H WALDRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 1400
JACKSONVILLE FL
32207-8340
US

IV. Provider business mailing address

PO BOX 44004
JACKSONVILLE FL
32231-4004
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-0000
  • Fax: 904-396-5206
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-396-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME68245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: