Provider Demographics
NPI:1760448864
Name:WALDROP, RICHARD J (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:WALDROP
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 1:7620 W LOWER BUCKEYE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7433
Mailing Address - Country:US
Mailing Address - Phone:623-936-0821
Mailing Address - Fax:623-478-9151
Practice Address - Street 1:7620 W LOWER BUCKEYE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7433
Practice Address - Country:US
Practice Address - Phone:623-936-0821
Practice Address - Fax:623-478-9151
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ590126Medicaid
AZF04019Medicare UPIN
AZZ105606Medicare PIN
AZZ72450Medicare PIN