Individual
GARY M WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 S LOOP 256, PALESTINE, TX 75801-6958
(903) 731-1084
Mailing address
4777 US HIGHWAY 259, LONGVIEW, TX 75605-7668
(903) 663-4800
(903) 663-0378
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K1716
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102048902
—
TX
Enumeration date
05/13/2006
Last updated
06/08/2012
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