Provider Demographics
NPI:1417580465
Name:WALDRON, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WALDRON
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 1:3815 HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-2367
Mailing Address - Country:US
Mailing Address - Phone:918-845-1076
Mailing Address - Fax:
Practice Address - Street 1:3815 HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421-2367
Practice Address - Country:US
Practice Address - Phone:918-845-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist