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General NPI Number Information
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NPI Number | 1326497504
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Entity Type | Individual
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Provider Name | JACOB E WALDRON D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 27351 DEQUINDRE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3487
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Country | US
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Telephone | 313-343-7110
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL MEDICAL CTR 34800 BOB WILSON DRIVE
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City | SAN DIEGO
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State | CA
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Zip | 92134-5000
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Country | US
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Telephone | 619-532-8429
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Fax | 619-532-8429
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101025805
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License Number State | MI
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