Provider Demographics
NPI:1396845616
Name:WALDROP, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:WALDROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:23550 PARK ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2592
Mailing Address - Country:US
Mailing Address - Phone:313-730-0500
Mailing Address - Fax:313-730-0606
Practice Address - Street 1:23550 PARK ST
Practice Address - Street 2:STE. 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2592
Practice Address - Country:US
Practice Address - Phone:313-730-0500
Practice Address - Fax:313-730-0606
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF59887Medicare UPIN
MI0Q24704Medicare ID - Type Unspecified