Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1809 | TX |
NPI | 1003334053 |
---|---|
Provider Name | Jeffrey Howard Waldmuller |
First Address | Richardson, TX 75081-4447 |
Second Address | Dallas, TX 75248-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2017 |
Last Update Date | 30/08/2017 |