Individual
MICHAEL JAMES WALDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 S NOLEN DR, SUITE B, SOUTHLAKE, TX 76092-9167
(817) 310-4490
(817) 310-4491
Mailing address
PO BOX 35629, DALLAS, TX 75235-0629
(214) 424-2200
(214) 231-2159
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
E1165
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114577301
—
TX
01
—
220006857
RAILROAD MEDICARE
TX
01
—
80P362
BCBS
TX
Enumeration date
08/03/2006
Last updated
02/23/2017
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