Provider Demographics
NPI:1952415994
Name:J WALDEN RETAN MD PC
Entity Type:Organization
Organization Name:J WALDEN RETAN MD PC
Other - Org Name:J WALDEN RETAN MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:WALDEN
Authorized Official - Last Name:RETAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-967-2900
Mailing Address - Street 1:3105 WARRINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BROOK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2721
Mailing Address - Country:US
Mailing Address - Phone:205-967-2900
Mailing Address - Fax:205-967-0069
Practice Address - Street 1:3105 WARRINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BROOK
Practice Address - State:AL
Practice Address - Zip Code:35223-2721
Practice Address - Country:US
Practice Address - Phone:205-967-2900
Practice Address - Fax:205-967-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3223207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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AL=========OtherUNITED HEALTHCARE