Individual
THEODORE A WAFLART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 W 9TH ST, JASPER, IN 47546-2514
(812) 481-5750
(812) 481-5763
Mailing address
PO BOX 1028, JASPER, IN 47547-1028
(812) 481-8493
(812) 481-8497
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
01027456A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10010907A
—
IN
Enumeration date
09/28/2006
Last updated
06/23/2010
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