Healthcare Provider Details

I. General information

NPI: 1326497504
Provider Name (Legal Business Name): JACOB E WALDRON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CAMPUS RIDGE DR STE 2200
MIDLAND MI
48640-6127
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-837-9280
  • Fax: 989-837-9330
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101025805
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101025805
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: