Provider Demographics
NPI:1679960041
Name:WALDRON, JOSEPH RANDALL (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RANDALL
Last Name:WALDRON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W TECUMSEH RD
Mailing Address - Street 2:STE 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:405-360-6769
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:STE 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-360-6764
Practice Address - Fax:405-360-6769
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK163172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker