Provider Demographics
NPI:1912990094
Name:WALDRIP, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:WALDRIP
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 1:12361 W BOLA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:623-584-5626
Mailing Address - Fax:623-544-9122
Practice Address - Street 1:12361 W BOLA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:623-584-5626
Practice Address - Fax:623-544-9122
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13525207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1912990094OtherAHCCCS
1912990994OtherBC/BS AZ OUT OF AREA
AZ730511OtherUNITED HEALTHCARE
AZ2Z3248OtherHEALTH NET
AZ256083Medicaid
AZ5124334OtherAETNA
AZAZ0334260OtherBCBS BLUECARD PROGRAM
256083OtherAHCCCS
200006477OtherRAILROAD MEDICARE
AZ2Z3248OtherHEALTH NET
AZZMD13525Medicare PIN
AZ20WCLCJ01Medicare PIN
AZ730511OtherUNITED HEALTHCARE
AZ256083Medicaid