Individual
LON ANDREW WALDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4018 EL INDIO HWY, EAGLE PASS, TX 78852-6690
(830) 872-3460
(830) 872-3470
Mailing address
2525 N VETERANS BLVD, EAGLE PASS, TX 78852-3302
(830) 773-8917
(830) 773-1892
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
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