Individual
PHILLIP DEWAYNE WALDRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8945 CLAIBORNE FARM DR, GERMANTOWN, TN 38138-8244
(901) 748-0468
Mailing address
8945 CLAIBORNE FARM DR, GERMANTOWN, TN 38138-8244
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0000028438
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133314001
—
AR
Enumeration date
06/08/2006
Last updated
07/08/2007
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