Provider Demographics
NPI:1689794620
Name:WALDROP, DEVIN VANCE (MD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:VANCE
Last Name:WALDROP
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-538-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL373092085R0202X
GA605122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA037732682CMedicaid
AL219137Medicaid
AL238933Medicaid
AL219858Medicaid
AL248096Medicaid
AL249591Medicaid
AL219854Medicaid
AL219868Medicaid
AL220095Medicaid
AL248093Medicaid
AL219134Medicaid
AL248511Medicaid
AL249348Medicaid
AL218986Medicaid
AL219012Medicaid
AL219135Medicaid