Provider Demographics
NPI:1619460854
Name:WAYTZ, JOSHUA GRAY (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GRAY
Last Name:WAYTZ
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 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-6026
Mailing Address - Country:US
Mailing Address - Phone:952-893-1959
Mailing Address - Fax:952-893-1954
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-6026
Practice Address - Country:US
Practice Address - Phone:952-893-1959
Practice Address - Fax:952-893-1954
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.072472207R00000X
IL036.155463207R00000X, 207RR0500X
MN73164207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine