Individual
REBECCA ANNE WALDRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
KEESLER AIR FORCE BASE MEDICAL CENTER, 101 FISHER ST, BILOXI, MS 39534
(228) 376-0500
Mailing address
3919 HANSHAW RD, OCEAN SPRINGS, MS 39564-9458
(319) 784-8079
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34.015002
OH
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
32648
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32648
MISSISSIPPI MEDICAL LICENSE
MS
01
—
34.015002
OHIO MEDICAL LICENSE
OH
Enumeration date
06/24/2019
Last updated
07/08/2024
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