Individual
DR. GLENN J WALDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2803 DORAL CT, LAS CRUCES, NM 88011-8616
(046) 984-4063
(877) 532-2113
Mailing address
1180 COMMERCE DRIVE #14222, LAS CRUCES, NM 88011-8255
(505) 695-1227
(877) 532-2113
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
A045921
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27552381
—
NM
Enumeration date
12/11/2006
Last updated
05/08/2024
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