Provider Demographics
NPI:1003449943
Name:WALDER, ALAN EUGEAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:EUGEAN
Last Name:WALDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 KAMMER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1126
Mailing Address - Country:US
Mailing Address - Phone:937-361-9248
Mailing Address - Fax:
Practice Address - Street 1:4145 KAMMER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1126
Practice Address - Country:US
Practice Address - Phone:937-361-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist