Individual
DR. BRETT JOSEPH WAVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
7840 VINEWOOD LN N, MAPLE GROVE, MN 55369-7185
(763) 236-0200
Mailing address
PO BOX 43, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016005725
IL
213E00000X
Podiatrist
1085-25
WI
213E00000X
Podiatrist
Primary
1165
MN
213E00000X
Podiatrist
DP201954
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
016005725
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
1085-25
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
DP201954
OR
Other
Enumeration date
05/01/2013
Last updated
09/19/2024
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