| Doctor Name: | JOHN J WADDELL |
| NPI Number: | 1497735724 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | R5P32 |
| Business Practice Address: | 1125 Madison St Jefferson City, MO - 651015227 |
| Business Phone Number: | 5736325265 |
| Business Fax Number: | 5736325948 |
| Mailing Address: | Po Box 7687, COLUMBIA |
| State: | MO |
| Postal Code: | 652057687 |
| Phone Number: | 5738822259 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2006 |
| NPI Last Update Date: | 08/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | R5P32 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| 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. |