Individual
DR. KEVIN GERARD WALDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24022 CALLE DE LA PLATA STE 415, LAGUNA HILLS, CA 92653-3630
(219) 381-0846
Mailing address
24022 CALLE DE LA PLATA STE 415, LAGUNA HILLS, CA 92653-3630
(219) 381-0846
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
01060759A
IN
207T00000X
Neurological Surgery Physician
036.113732
IL
207T00000X
Neurological Surgery Physician
Primary
C147602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0375788
ANTHEM
IN
01
—
129164100
INDIANA DEPT OF LABOR
IN
05
—
200800980
—
IN
01
—
P00298697
PALMETTO RR MEDICARE
IN
Enumeration date
06/14/2006
Last updated
09/03/2025
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