Individual
WALTER C DANDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MERCY WAY, STE 440, JOPLIN, MO 64804-4524
(417) 781-4404
(417) 781-5845
Mailing address
100 MERCY WAY, STE 440, JOPLIN, MO 64804-4524
(417) 781-4404
(417) 781-5845
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R6557
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100099510A
—
OK
05
—
100167010E
—
KS
05
—
1316985815
—
MO
01
—
P00800462
RAIL ROAD MEDICARE
MO
Enumeration date
06/04/2006
Last updated
03/17/2016
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