Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 96-153 | NM |
NPI | 1063429017 |
---|---|
Provider Name | J. Waldman |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |