Individual
DAVID J WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 SAPPINGTON BRIDGE RD, SULLIVAN, MO 63080-2354
(573) 468-4186
Mailing address
751 SAPPINGTON BRIDGE RD, SULLIVAN, MO 63080-2354
(573) 468-4186
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2023006560
MO
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
31608
IA
208M00000X
Hospitalist Physician
Primary
2023006560
MO
208M00000X
Hospitalist Physician
E9142
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0148593
—
IA
01
—
110149386
RR MEDICARE
IA
05
—
208691204
—
MO
05
—
209747001
—
AR
01
—
419099YWUJ
MEDICARE
AR
01
—
421202636
TAX ID
IA
Enumeration date
08/05/2006
Last updated
08/01/2023
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