Individual
JOHN J WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5265
(573) 632-5948
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
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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