Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 00006502 | FL |
NPI | 1063623635 |
---|---|
Provider Name | Joseph March Waldron |
First Address | Gainesville, FL 32607-1425 |
Second Address | Gainesville, FL 32607-6029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |