Individual
HENRY DOUGLAS WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3660 VISTA AVE, SUITE 207, SAINT LOUIS, MO 63110-2540
(314) 977-6100
(314) 977-6137
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R4D18
MO
Other
Enumeration date
08/14/2006
Last updated
03/30/2009
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