Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 19666 | LA |
N | 207PP0204X | Pediatric Emergency Physician | 0101241333 | VA |
Y | 2080P0204X | Pediatric Emergency Doctor | 32185 | AL |
NPI | 1376656892 |
---|---|
Provider Name | Ronnie Dell Waldrop |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 09/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C67705 | (02) | LA |