Provider Demographics
NPI:1235758442
Name:WALDE, RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:WALDE
Suffix:
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 1:2451 UNIVERSITY HOSPITAL DR.
Mailing Address - Street 2:MOORER BLDG. ROOM 120
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617
Mailing Address - Country:US
Mailing Address - Phone:251-471-7786
Mailing Address - Fax:251-471-7884
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR.
Practice Address - Street 2:MOORER BLDG. ROOM 120
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617
Practice Address - Country:US
Practice Address - Phone:251-471-7786
Practice Address - Fax:251-471-7884
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALL.5579R390200000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology