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General NPI Number Information
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NPI Number | 1659392900
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Entity Type | Organization
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Legal Business Name | DAVID A WALD MD PA
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 2320 NE 62ND ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-2208
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Country | US
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Telephone | 954-772-2880
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Fax | 954-772-2848
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Provider Business Mailing Address
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Address Line | 2545 E SUNRISE BLVD # 234
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3203
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Country | US
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Telephone | 954-772-2880
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Fax | 954-772-2848
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Authorized Official
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Title or Position | OWNER
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Name | DAVID A WALD
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Credential | MD
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Telephone | 954-772-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME 83180
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License Number State | FL
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