Provider Demographics
NPI:1184724742
Name:WALDBY, GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:WALDBY
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 1:3700 S WESTPORT AVE # 3014
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-6360
Mailing Address - Country:US
Mailing Address - Phone:605-212-8944
Mailing Address - Fax:866-533-9909
Practice Address - Street 1:3700 S WESTPORT AVE # 3014
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-6360
Practice Address - Country:US
Practice Address - Phone:605-212-8944
Practice Address - Fax:866-533-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30363208600000X
KS04-18487208600000X
MN26886208600000X
MO102806208600000X
NE19963208600000X
SD3958208600000X
MT10609208600000X
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000026338Medicaid
MT0080716Medicaid
SD7300810Medicaid
IA0126912Medicaid
MT0000026338Medicaid
MTC49902Medicare UPIN
MNC49902Medicare UPIN
MT00084195Medicare ID - Type Unspecified
MO0004097Medicare ID - Type Unspecified
IA0126912Medicaid
SD7300810Medicaid