| Doctor Name: | DR. JERRY L WAIKINS |
| NPI Number: | 1629032974 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME19703 |
| Business Practice Address: | 551 National Health Care Dr Daytona Beach, FL - 321141495 |
| Business Phone Number: | 3862525273 |
| Business Fax Number: | |
| Mailing Address: | 117 Meadowbrook Cir, DAYTONA BEACH |
| State: | FL |
| Postal Code: | 321141164 |
| Phone Number: | 3864923243 |
| Fax Number: | 3864923243 |
| NPI Enumeration Date: | 04/13/2006 |
| NPI Last Update Date: | 08/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME19703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |