Provider Demographics
NPI:1790733301
Name:WALDON, GENE BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:BRUCE
Last Name:WALDON
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 1:3000 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-553-2524
Mailing Address - Fax:479-553-2522
Practice Address - Street 1:3000 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-553-2524
Practice Address - Fax:479-553-2522
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28692207R00000X, 208M00000X
ARC4981208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500601380Medicaid
E10177Medicare UPIN
ORE10177Medicare UPIN
ORR143023Medicare PIN