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General NPI Number Information
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NPI Number | 1265629398
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Entity Type | Organization
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Legal Business Name | WALDEN FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 3504 CORINTH PARKWAY SUITE 150
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City | CORINTH
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State | TX
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Zip | 76208
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Country | US
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Telephone | 940-498-4445
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Fax | 940-270-5002
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Provider Business Mailing Address
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Address Line | 3504 CORINTH PARKWAY SUITE 150
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City | CORINTH
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State | TX
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Zip | 76208
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Country | US
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Telephone | 940-498-4445
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Fax | 940-270-5002
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACCI GAYLE WALDEN
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Credential | M.D.
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Telephone | 940-498-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L4162
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License Number State | TX
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