Provider Demographics
NPI:1669418455
Name:WALDRON, DAVID T (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:WALDRON
Suffix:
Gender:M
Credentials:PA
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 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 N 1100 E STE 103
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2940
Practice Address - Country:US
Practice Address - Phone:801-492-2330
Practice Address - Fax:801-492-2375
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3510331206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00023902OtherPALMETTO
UT10703135101OtherIHC
UTS64600Medicare UPIN
UT0651550002Medicare NSC
UT005502580Medicare ID - Type UnspecifiedMEDICARE