Provider Demographics
NPI:1952359838
Name:WALDREP, JAMIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:WALDREP
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 1:250 STRICKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4750
Mailing Address - Country:US
Mailing Address - Phone:409-883-7900
Mailing Address - Fax:409-883-7909
Practice Address - Street 1:250 STRICKLAND DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4750
Practice Address - Country:US
Practice Address - Phone:409-883-7900
Practice Address - Fax:409-883-7909
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182037501Medicaid
TX182037501Medicaid
TXI59791Medicare UPIN