Doctor Name: | GLEN E WALDNER |
NPI Number: | 1235271016 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CPO LPO |
License Number: | 183 |
Business Practice Address: | 2865 Zelda Road Montgomery, AL - 36106 |
Business Phone Number: | 3343958118 |
Business Fax Number: | 3343958119 |
Mailing Address: | 126 Sycamore Drive, PRATTVILLE |
State: | AL |
Postal Code: | 36066 |
Phone Number: | 3347304835 |
Fax Number: | |
NPI Enumeration Date: | 02/12/2007 |
NPI Last Update Date: | 02/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 183 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |