Provider Demographics
NPI:1164490355
Name:WALDEN, JAMES MADISON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MADISON
Last Name:WALDEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1238
Mailing Address - Country:US
Mailing Address - Phone:816-803-8600
Mailing Address - Fax:
Practice Address - Street 1:1300 NW BRIARCLIFF PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64150-7104
Practice Address - Country:US
Practice Address - Phone:816-527-0031
Practice Address - Fax:816-527-0096
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36414207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC51376Medicare PIN