Provider Demographics
NPI:1902801871
Name:WALDMAN, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 UNIVERSITY AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5247
Mailing Address - Country:US
Mailing Address - Phone:903-935-1151
Mailing Address - Fax:903-935-0077
Practice Address - Street 1:304 UNIVERSITY AVE
Practice Address - Street 2:STE 212
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5247
Practice Address - Country:US
Practice Address - Phone:903-935-1151
Practice Address - Fax:903-935-0077
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-6674207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1597776-01Medicaid
TX00900HMedicare PIN
TX1597776-01Medicaid