Individual
DR. MARK S WALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6 JUNGERMANN CIR, SUITE 210, SAINT PETERS, MO 63376-1621
(636) 441-6056
Mailing address
11133 DUNN RD, SUITE 2335, SAINT LOUIS, MO 63136-6119
(314) 653-5007
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
036081636
IL
207RP1001X
Pulmonary Disease Physician
Primary
R8691
MO
207RS0012X
Sleep Medicine (Internal Medicine) Physician
036081636
IL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
R8691
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201751005
—
MO
01
—
290009909
RR MEDICARE PCI
MO
01
—
29007538
RR MEDICARE PSC
MO
Enumeration date
11/02/2005
Last updated
07/31/2012
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