Individual
JOHN J WADDELL
Active
Individual
JOHN J WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R5P32
MO
2085R0202X
Diagnostic Radiology Physician
Primary
R5P32
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208691345
—
MO
01
—
3239466A
RAILROAD MEDICARE-INDIV
MO
01
—
3239466B
RAILROAD MEDICARE- INDIV
KS
01
—
792000001
TPAN CMS
MO
01
—
CI2562
RAILROAD MEDICARE- GROUP
KS
01
—
CI3618
RAILROAD MEDICARE- GROUP
MO
Enumeration date
01/20/2006
Last updated
08/29/2008
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