Individual
MR. DAKE R WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1 RAMS WAY, EARTH CITY, MO 63045-1523
(314) 516-8735
(314) 516-8777
Mailing address
1 RAMS WAY, EARTH CITY, MO 63045-1523
(314) 516-8735
(314) 516-8777
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
110382
MO
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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