Individual
LON ANDREW WALDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
J3931
TX
207RI0011X
Interventional Cardiology Physician
J3931
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1360869-02
—
TX
05
—
1360869-05
—
TX
05
—
1360869-11
—
TX
05
—
136086909
—
TX
01
—
4376993
AETNA PROVIDER ID
TX
01
—
86462K
BCBS
TX
Enumeration date
05/11/2006
Last updated
09/11/2024
Update your record
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