Provider Demographics
NPI:1700043288
Name:WAITE, ALEXANDER MANSON (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MANSON
Last Name:WAITE
Suffix:
Gender:M
Credentials:DO
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 325
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0325
Mailing Address - Country:US
Mailing Address - Phone:336-789-2922
Mailing Address - Fax:336-789-0856
Practice Address - Street 1:105 N CRUTCHFIELD ST # 2
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8804
Practice Address - Country:US
Practice Address - Phone:336-789-2922
Practice Address - Fax:336-789-0856
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10189207Q00000X
VA0102207506207Q00000X
NC2008-01963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913821Medicaid
NCP00835720OtherRAILROAD MEDICARE PTAN
NC154MROtherBCBS OF NC
NC154MROtherBCBS OF NC