Provider Demographics
NPI:1760719272
Name:WALDMAN, WALLACE E (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:E
Last Name:WALDMAN
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 1:721 CONCHSHELL MANOR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2901
Mailing Address - Country:US
Mailing Address - Phone:954-472-2767
Mailing Address - Fax:
Practice Address - Street 1:721 CONCHSHELL MANOR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2901
Practice Address - Country:US
Practice Address - Phone:954-472-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23019207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology