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Individual
KENNETH B WAITES
Active
Individual
KENNETH B WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
101513
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010033CC76902
SECTION 1011
AL
01
—
C76902
VIVA
AL
Enumeration date
07/26/2006
Last updated
07/08/2007
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