Provider Demographics
NPI:1730120197
Name:WALDRON, ANNE H (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:H
Last Name:WALDRON
Suffix:
Gender:F
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 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-396-5206
Practice Address - Street 1:836 PRUDENTIAL DR STE 1400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8340
Practice Address - Country:US
Practice Address - Phone:904-396-0000
Practice Address - Fax:904-396-5206
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG21249Medicare UPIN
FL26939VMedicare PIN
FL26939WMedicare ID - Type Unspecified
FL26939VMedicare PIN